CEO, Adrian Velasquez and COO, Christine Krause have always recognized the benefits to physicians of using a lockbox service and prior to creating Fi-Med’s internal bank and lockbox service, they used to encourage all of their clients to use a lockbox if at all possible. Unfortunately, not all banks provided lockbox services to their customers, and those who did often charged very high fees making the use of a lockbox not a very practical solution for most physicians.

Adrian and Christine consulted with several banks in order to find an affordable solution for their clients. As they began to work with banks they realized that there was a very important component to the lockbox process that all banks were missing. The problem? Banks don’t understand medical billing. They don’t understand what an Explanation of Benefits (EOB) is. They have scanning technology but their employees aren’t trained to recognize and capture all the important information that a medical practice needs. They don’t do this intentionally, they just don’t understand how medical billing works. Adrian and Christine realized that in order to provide the best service to their clients, they were going to need to create it themselves.  

The  Fi-Med lockbox brings the best of both worlds to our clients—the security and efficiency of a  lockbox that is more affordable than most traditional bank lockboxes, combined with years of medical billing experience. Fi-Med’s lockbox is more affordable than most traditional lockboxes. There is no need to change your existing banking relationship, payments are immediately scanned and deposited by ACH into your bank account of choice and you can view daily deposit activity online.

The Fi-Med lockbox service trims more than a week off the normal payment cycle for most clients and  eliminates time spent opening and sorting checks and Explanation of Benefits (EOB), filling out deposit slips and taking deposits to the bank. Fi-Med’s lockbox service takes human error at the office level out of the equation, completely eliminates the potential of employee theft and makes account reconciliation faster and easier. 

Fi-Med staff is bonded and follows GAAP in the separation of duties and responsibilities. Fi-Med is committed to excellence, offering its clients reduced costs so that they can concentrate on maintaining a high level of care for their patients and a competitive advantage.

Historical patterns also suggest that all empires and times of excess eventually come to an abrupt end. We tend to mark the ages of man by the main national force of the time frame, chronicling the times of lapsed cultural powers, from Ancient Egypt to Greece to Rome. The modern advantage we all share is the ability to review history and learn from it. When we embrace the lessons learned, humanity has the ability to come out on the other side of lean times stronger than ever before.

Our country currently finds itself in a profound time of economic challenge, which threatens the stability of long-established institutions. With the U6 unemployment rate (which measures total unemployed, underemployed and long-term unemployed only marginally attached to the workforce) currently measuring at 17.9%, effects begin to move through parts of our economy at different rates. There is a feeling in our industry that the economy has unceremoniously arrived at the door of the healthcare delivery system. Combine our current economic morass with the double-digit premium increases foisted upon those who still have coverage from the health insurance sector (none of which is returned to healthcare providers in the form of more favorable contract terms) and it becomes of paramount importance to look for unexplored ways to increase collections.

There is a direct correlation between the reduction of workers and the increase in the self-pay population presenting for healthcare services. This burgeoning population requires increased due diligence on the part of registration and front-desk staff to minimize the impact of this group on a provider’s bottom line. The following simple steps can assure that providers protect themselves and retain full value for their services:

• Insurance Demographic Verification – When an established patient either presents for services or contacts you for an appointment for future services, verify that the patient’s coverage is still in force. This will give both parties a clear picture of the patient’s liability for services rendered.
• Know Your Fees – The self-pay population, particularly a provider’s established patients, will want to know their liability for services. Having your fees for certain services on hand will help front-end staff in designing a payment schedule for the patient.
• Compliance Awareness – Routine blanket waivers of co-payments, deductible and coinsurance are considered a violation of federal law if you see Medicare or Medicaid patients in your practice. Federal law does allow for economic relief for a patient due to financial hardship. In each case where a patient requests forgiveness of all or a portion of their outstanding balance, economic information unique to that patient should be taken into account before arriving at a dollar amount.
• Know Your Referral Rules – Specialists must be acutely aware of referral and prior authorization rules and requirements for insurances utilized in their area. Without this knowledge, the number of non-covered services for patients with active insurance coverage needlessly increases, often with no opportunity for appeal. There are some carriers that will allow for retro-authorization, but this is not such a large number that a provider should gamble with reimbursement of legitimate services.

Thin times often call for defensive measures. With the understanding that each provider’s field of practice offers with it unique considerations, internalizing and following the above steps can provide a healthy head start towards seeing a practice from current lean times to (hopefully) brighter and heavier days ahead.

The latest temporary measure was to be attached to another measure granting an extension of unemployment benefits for 12 million people whose benefits have run out. Jim Bunning, the senior senator from Kentucky currently in his final term, filibustered the bill based on the bill either not having equal cuts in spending to pay for itself or because the funds for the bills would not come from leftover money from an earlier stimulus package. The Democratic majority was unable and/or unwilling to break the filibuster, and the Senate has now adjourned until Monday. 

CMS has since issued a press release that states that they are instructing the MAC’s to place a hold on claims for the first 10 business days in March. It is believed that this will provide ample time for Congress to issue another temporary payment fix.  

It was 104 years ago today that my grandmother was born in the western suburbs of Philadelphia. Some of the only positive memories I hold of my childhood stem from the time I spent with my grandmother in her kitchen. She had a breakfast table in her kitchen that looked out upon her back yard. Just beyond her backyard was the Route 100 line, that sent trolley cars from 69th Street in Philadelphia to their final destination to the west, in Norristown, with many stops in between. It was easy to get lost in the great potential the world offers a small child standing in her backyard on a sunny day, with the subtlest hint of clouds in the sky and the clickety-clack of the trolley passing every 15 minutes. 

My grandmother left this world in April of 1994, In the nearly 16 years since, the memories I’ve carried with me of the time I spent by her side reappear at strange times. It could be the sound of a distant train or the smell of her veal recipe that I still make for my wife and son from time to time. Yet when her memory comes forward, after remembering a funny story or a brief glimmer of a moment in past time when the two of us occupied the same space, the very last thing I feel when such memories arise is loss, and the change in my life that losing this one person brought forward. One can only dance inside their head for an instant before the reality of subtraction appears before them. 

Which brings me to today’s urgent topic. Over the past 6 weeks, the medical community has watched with a combination of anger and exhaustion as Congress has failed to definitively act on the issue of the 21.3% decrease in Medicare payments set to take effect this coming Monday. As I type this, yet another piece of legislation has been introduced to delay the pay cut until March 28th, which would create yet another window of opportunity to create a permanent solution to this annual occurrence. 

As I described in an earlier post on this topic, we have become desensitized to this process, as a white knight with long flowing hair, cleverly disguised as the latest legislative stay of execution, has until now always arrived in the twilight moments of the latest deadline. With the two days between now and March 1st falling on a weekend, the possibility exists that perhaps this is the time when the knight has either fallen asleep or found other worlds to save. 

While it is certainly within the realm of possibility based on past precedent that a temporary pay fix will pass before the Monday deadline, the sobering reality still exists that no fix may be coming. A question immediately appears in my head, wondering how many physicians have truly prepared themselves for this darker eventuality. If someone in this industry takes a moment to imagine the medical delivery landscape in a world where 21% of the largest payer’s receivables suddenly disappear like water vapor, it is more than likely a post-apocalyptic vision. 

Lou Reed, with a mix of poetry and a New Yorker’s gift for blunt assessment, once wrote “There’s a bit of magic in everything/and then some loss to even things out”.  The healthcare system now finds itself facing an unwelcome loss, while once again hoping for the annual act of prestidigitation that makes a pay cut disappear right in front of your eyes. While those of us involved in the industry can do all we can in the next few days by inundating Congress with faxes and telephone calls demanding a remedy to this situation, be mindful of what this change actually means to our system. Without that awareness, the reimbursement realities of today could become the memories and sense of loss of Monday.

What makes slapstick comedy gratifying is the belief that it exists strictly in the realm of entertainment. In real life, we tend not to see pie fights at society parties, wars won because the leader of the enemy country is being pelted into submission with fruit or adults getting hit square in the face while playing dodgeball. We tend to think that institutions can’t descend into complete and utter chaos due to one bad decision, yet the process looks really easy to accomplish with the right script, the right actors and a skill for setting up a humorous situation.

In the absence of an abundance of banana peals and squirt bottles full of seltzer water, the closest parallel we have to slapstick comedy in our daily lives is the decision-making process of our federal government, particularly in relation to its unctuous administrative giveaways to large American businesses. As an illustrative example, I present Palmetto GBA, which in the past two years has quickly risen to the top of the list as a California physician’s least favorite wholly owned subsidiary of Blue Cross & Blue Shield of South Carolina.

During the last presidential administration, someone in government decided that it would be a wonderful idea to take the assignment of Medicare contractors for some states and shift them to other contractors. As part of that decision, Palmetto GBA, who until 2008 had been responsible for some of the smaller states in this country, was given oversight of the state of California, which by itself is the 7th largest economy in the world. Simultaneously, the decision was made to move every provider to a National Provider Identifier (NPI). 

What was planned was a smooth transition from one carrier to another with an accompanying, long-awaited transition to a single provider ID number. What resulted in mid-2008 was comparable to Lucy and Ethel at the candy factory, with too little staff assigned to too big a task. This would be the perfect situation for high comedy were it not for the fact that it sent tens of thousands of medical practices in America’s largest state to the brink of bankruptcy due to long-delayed NPI enrollment applications and lack of staff to answer basic questions leading to resolution.

In the fall of 2008, a flurry of press releases emanated from Palmetto GBA in typical corporate style stating that the problems were being addressed, additional staff was being added post-transition and that everything was going to suddenly metamorphose into a fantasy land of fairies, elves, candy buttons, marshmallow clouds and rivers of pure chocolate.  In the roughly 18 months since, it can be successfully argued that the same problems still exist, only instead of NPI, Palmetto GBA has now demonstrated their lack of readiness a second time with their approach to the PECOS/referring physician database issue.

As an illustrative example, one of our California providers, was having a problem with his Provider Transaction Account Number (PTAN). When our credentialing specialist contacted Palmetto GBA, the person answering the phone stated that the physician did not have an individual PTAN. It was shortly after this that the physician received a letter stating that the same supposedly non-existing individual PTAN was being deactivated. Further investigation revealed that this stemmed from a suite number in the correspondence address being entered incorrectly in Palmetto’s system, which in turn caused a conflict with the PECOS system, hence the threatened deactivation.

Mercifully, CMS has now delayed Phase II of the PECOS project until January 3, 2011, which gives Palmetto GBA roughly 10 months to discover another integral process for which they lack either competent staff or updated information. The lesson of California’s painful transition is still playing out, as the last 14 states in the five jurisdictions yet to go through administrative carrier transition are being delayed due to protests being lodged with CMS. This affects the four additional states that will be under Palmetto GBA after final transition. Spare a little pity for the provider communities in the Carolinas, Virginia and West Virginia after all is said and done.

All of this provides an abject lesson in governmental process. It is hoped in the future that legislative changes with profound financial side effects will more resemble a workable, functional business model rather than a 3-dimensional tribute to Larry, Moe and Curly.

It turns out that the annoying cough I’ve been fighting for the last week is actually bronchitis. For this, my urgent care physician prescribed a Z-Pack and $50 cough syrup that makes you drowsy. To spare the reader, I skipped the cough syrup for this post, as it’s a fine line between an industry blog posting and William Burroughs’ Naked Lunch. I’ll be brief, and hopefully effective.

Two updates of note came to light this week. First, on January 4th, Medicare was to implement a rule clarifying date of service and place of service rules for interpretation of diagnostic tests. These rules stated that the date of service and place of service of the interpretation of diagnostic tests should be when and where the interpretation was performed, and not the date and place of the performance of the test. Thankfully, on February 5th, this new rule was postponed indefinitely due to mass provider confusion. The policy could be reviewed at a later date for future implementation.

The second update follows up on my last posting here regarding the 2010 Medicare Physician Fee Schedule. Thanks to the snowstorms that pounded the East Coast this week, which led to a federal government

Today is February 5th, and being that this is the shortest month of the year (think of February as Tattoo and the calendar as Fantasy Island), I count that there are 23 days left until Medicare will begin instituting a 21.3% pay cut across the board for all physicians. Seeing as a cut of this magnitude immediately places countless medical providers is dire straits, and by extension our clinic-based medical infrastructure in jeopardy, one would think that this issue would be at the top of the list for a country that embraced “promote the general welfare” as a founding ideal of the nation. So it is with surprise that upon looking at the Congressional calendar for February that Congress is giving themselves a break for the entire week beginning February 15th. This drops the actual days to fix the problem to roughly 18, but anyone who has ever tortured themselves watching C-SPAN can tell you, U. S. Congressional work must be judged on quality of time spent, and not quantity.

Physicians are already taking a financial hit in 2010 with the Medicare’s elimination of reimbursement for consultation codes. As specialty organizations urgently lobby their members to contact Congress to issue a fix, Congress is snapping into action by taking 5 days off.

I spend my work days being a physician advocate. While it is not the place in life that I pictured for myself in my childhood, I think of myself as a very important part of our healthcare system as it is currently configured. Physicians spend 10+ years being trained to solve the myriad issues involved with the inner workings of the human body. We don’t contact a physician when we’re feeling great. A doctor is called when something is wrong. I object to this being  referred to as “A God complex” as so many do, as this is not a preordained royal imprimatur, but rather an outcropping of the decade or more of training necessary to understand and positively restore human beings to maximum function. I feel I owe it to a physician to take financial worries off the table and let them concentrate on what they have been trained to do.

I had five doctors in my family ranging across four different medical specialties. I find the scientific healing of the sick to be a fascinating world, not only for what is known about the human body, but what remains unknown as well. Had I been a better student (a FAR better student), it’s very possible that I could have ended up on the clinical side of health care rather than the administrative. As it is, my mind is geared more for appreciation of physicians rather than the occupation itself. Having said that, with the current insurance landscape, the work I and others on this side of the healthcare industry explore through on a daily basis (when exactly this became an “industry” rather than a noble trade, is long forgotten), from tracking down every possible dollar of reimbursement to helping design defensible documentation for medical services, takes on increased importance. None of us should gain any joy from knowing that our doctor is up in the middle of the night not solving the problems of a sick patient, but rather contemplating their financial future.

If you’ve been in this industry for any length of time, you become desensitized to the annual rite of Congress reversing a well-publicized physician payment cut. It is analogous to a long-term hostage-taking, where after a while being chained to an oil heater in a basement, being beaten and tortured and living on bread and water becomes a new standard by which to measure “normal”. If no one else is going to stand up and say it, I will. This latest deadline to end all deadlines isn’t business as usual, and it’s not something we should just get used to and coexist alongside, awaiting the usual temporary solution. It’s sick, it’s depraved and it has to stop.

The latest temporary measure was to be attached to another measure granting an extension of unemployment benefits for 12 million people whose benefits have run out. Jim Bunning, the senior senator from Kentucky currently in his final term, filibustered the bill based on the bill either not having equal cuts in spending to pay for itself or because the funds for the bills would not come from leftover money from an earlier stimulus package. The Democratic majority was unable and/or unwilling to break the filibuster, and the Senate has now adjourned until Monday. 

CMS has since issued a press release that states that they are instructing the MAC’s to place a hold on claims for the first 10 business days in March. It is believed that this will provide ample time for Congress to issue another temporary payment fix.  

It was 104 years ago today that my grandmother was born in the western suburbs of Philadelphia. Some of the only positive memories I hold of my childhood stem from the time I spent with my grandmother in her kitchen. She had a breakfast table in her kitchen that looked out upon her back yard. Just beyond her backyard was the Route 100 line, that sent trolley cars from 69th Street in Philadelphia to their final destination to the west, in Norristown, with many stops in between. It was easy to get lost in the great potential the world offers a small child standing in her backyard on a sunny day, with the subtlest hint of clouds in the sky and the clickety-clack of the trolley passing every 15 minutes. 

My grandmother left this world in April of 1994, In the nearly 16 years since, the memories I’ve carried with me of the time I spent by her side reappear at strange times. It could be the sound of a distant train or the smell of her veal recipe that I still make for my wife and son from time to time. Yet when her memory comes forward, after remembering a funny story or a brief glimmer of a moment in past time when the two of us occupied the same space, the very last thing I feel when such memories arise is loss, and the change in my life that losing this one person brought forward. One can only dance inside their head for an instant before the reality of subtraction appears before them. 

Which brings me to today’s urgent topic. Over the past 6 weeks, the medical community has watched with a combination of anger and exhaustion as Congress has failed to definitively act on the issue of the 21.3% decrease in Medicare payments set to take effect this coming Monday. As I type this, yet another piece of legislation has been introduced to delay the pay cut until March 28th, which would create yet another window of opportunity to create a permanent solution to this annual occurrence. 

As I described in an earlier post on this topic, we have become desensitized to this process, as a white knight with long flowing hair, cleverly disguised as the latest legislative stay of execution, has until now always arrived in the twilight moments of the latest deadline. With the two days between now and March 1st falling on a weekend, the possibility exists that perhaps this is the time when the knight has either fallen asleep or found other worlds to save. 

While it is certainly within the realm of possibility based on past precedent that a temporary pay fix will pass before the Monday deadline, the sobering reality still exists that no fix may be coming. A question immediately appears in my head, wondering how many physicians have truly prepared themselves for this darker eventuality. If someone in this industry takes a moment to imagine the medical delivery landscape in a world where 21% of the largest payer’s receivables suddenly disappear like water vapor, it is more than likely a post-apocalyptic vision. 

Lou Reed, with a mix of poetry and a New Yorker’s gift for blunt assessment, once wrote “There’s a bit of magic in everything/and then some loss to even things out”.  The healthcare system now finds itself facing an unwelcome loss, while once again hoping for the annual act of prestidigitation that makes a pay cut disappear right in front of your eyes. While those of us involved in the industry can do all we can in the next few days by inundating Congress with faxes and telephone calls demanding a remedy to this situation, be mindful of what this change actually means to our system. Without that awareness, the reimbursement realities of today could become the memories and sense of loss of Monday.

Adrian and Christine began Fi-Med Management as a financial medical management consulting firm in 1993.  As the healthcare environment continues to evolve we return to our roots in assisting the independent physician maximizing revenue and reducing operational expenses.  A sneak peak on consulting services includes sophisticated analytics including E&M and Acuity Analysis, Fee Schedule Analysis, Cost and Contract Profitability, and Productivity Analysis to name a few.  Continue to look for additional details on these consulting services.

In the more than 20 years following, Spencer’s expertise won him job offers in claims analysis, consultation, and coding and compliance supervision at top healthcare organizations like SmithKline Beecham and Aurora Advanced Healthcare – as well as committee appointments for process improvements, planning, and technology quality control. He earned his CPC and CPC-H designations through the American Academy of Professional Coders (AAPC) in 1998. His experience spans the full spectrum of medical billing, from the fine detail of coding and auditing to big-picture policy interpretation and planning.

In 2008, with the finely-tuned, wide-ranging knowledge and experience from those 20 years in tow, Spencer arrived at Fi-Med Management, Inc. to take the helm as Compliance and Denial Management Officer. Quickly recognizing the talent and leadership they had acquired, Fi-Med designated Spencer as the company’s chief industry blogger – helping clients, payors and other medical billing professionals to navigate fast-changing industry regulations. In-depth coverage of topics like electronic medical records, e-prescriptions, documentation, new coding rollouts, and the changing healthcare billing landscape positioned Spencer as a go-to resource for Fi-Med clients and staff.

Challenging in any revenue cycle management firm, Spencer’s work at Fi-Med is doubly demanding in an environment experiencing full-throttle expansion, from organic market growth to strategic acquisitions. When he’s not passing along critical information on the official Fi-Med blog, Spencer is training new coding and compliance personnel, coaching current personnel on industry changes, trouble-shooting client denials and counseling them on best practices to stay one step ahead in the reimbursements arena.

Spencer lives in the Milwaukee area with his wife and son. An accomplished local folk rock singer/songwriter, he’s recorded two albums, plays live at local venues around eastern Wisconsin, and is a co-founder of a Milwaukee songwriters group.

As Fi-Med’s certified compliance consultant and operations leader, Christine has brought to independent medical practice’s a re-engineered “billing” office, expanding it into the efficient and compliant business management of accounts receivable. Christine worked alongside Adrian Velasquez to form and build Fi-Med Management, Inc. in 1993 with the common vision: aiding independent physicians in increasing profits, reducing compliance risk and creating, and maintaining, a healthy practice.

Christine brings to Fi-Med a unique and powerful blend of healthcare and business experience, along with a double major in accounting and business management at Lakeland College where she graduated magna cum laude. She is a certified compliance consultant and member of the Medical Group Management Association, American College of Healthcare Executives, Healthcare Compliance Resources, and Comprehensive Medical Practice Analysts.

Her contributions to the community include serving on the board of NewCastle Place, Inc., EastCastle Place, Inc. and Milwaukee Protestant Home, Inc. She also volunteers her time as an election official in Elm Grove, WI.

Christine’s Awards & Nominations

Selected to receive “Wisconsin’s 2007 Small Business Person of the Year Award”
Received Certificate of Special Congressional Recognition in recognition of outstanding and invaluable service to the community.
Nominated for Women of Distinction Award
Nominated for Women of Influence Award