The Monster That Grew Small.
We sell office management software-a complete program that saves time and labor in every aspect of the practice. Our sales representatives sometimes make cold calls, where they just pop into doctor’s offices. Recently, one of our reps stopped by an office and was surprised to see the receptionist typing an insurance form. After talking with her for a few moments and hearing the grumbles about the constant typing, the sales rep suggested a demonstration of our software, showing the woman how much time she could save every month and how much more quickly they would receive reimbursement. The receptionist’s response? “We’re just too busy to get a computer.” The sales rep was floored-the receptionist was dead serious!
I guess I have become more jaded through the years. The answers (excuses) that people use for inefficiency no longer surprise me. Experience just reinforces the fact that people resist change, resist leaving their comfort zones. For years, I have consulted with chiropractors, helping them to become more efficient in collections, insurance billing, office management, etc. For years, I have watched people stumble all over themselves with inefficiency, complaints about the system, grumbling about the wasted time, and continuing to do it the same way year after year. I have watched chiropractors waste incredible amounts of human resources because they feared the unknown.
There is a wonderful children’s book by Joan Grant, “The Monster That Grew Small.” The book talks about a fire-breathing dragon that scares an entire village. For years, villagers have lived in fear of it even though no one has seen it. A young boy, summoning every ounce of courage, decides to kill the dragon so he walks up the mountain to the cave. A curious thing happens. The closer he gets to the monster, the smaller it appears. If he runs away because he lets the fire scare him, the monster becomes huge.
When he finally meets the monster face-to-face, it fits inside his hand. The boy returns to the village with the monster as his pet. What’s the monster that grew small? Fearof what might have been!
One doctor I talked with refused to computerize because he might lose all of his patient records if the computer crashed. My response? What would happen right now if your office burned down? You’d lose all of your patient records, right? If you were computerized, performed rotational backups and stored a copy off-site once a week, you would lose, at most, one week of data rather than everything! It is time to put fear in perspective.
Another doctor wouldn’t ask patients for referrals for fear that the patients would lose respect for him. What’s the worst-case scenario? You ask and the patient thinks to himself “no way.” So what? What have you lost? The next time your patient encounters someone who needs chiropractic, you have planted the seed for referral. Let’s put fear in perspective.
Whatever excuses you are using for inefficiency or lack of growth, let’s put them in perspective. The fear monster grows small when you are face-to-face with it. Who knows, you might even take it home as a pet!
Are You an Electronic Claims Dinosaur?
While he was adjusting me, my chiropractor and I started talking about electronic billing. “You know Dr. Dinosaur?” he asked. “He has a computer and software, but they still send all their claims in hard copy form.”
“Yeah, I know him,” I replied. “Why don’t they send electronic?”
“He says that the electronic part of their software doesn’t work right. Besides, he gets payment just fine-in six to eight weeks.”
My chiropractor chuckled. “I told him that he needs to get better software. I send my Blue Cross on Wednesday; I get a check the following Thursday. I just love this electronic billing. It’s money in the bank!”
You may think I made up this conversation just for this article, but I didn’t. It actually happened two days ago. The only thing I changed was the name of the doctor. He was renamed Dr. Dinosaur because it seemed appropriate. Anyone who is not using electronic submission is a dinosaur by today’s standards. If the thought of electronic submission scares you, read on. Sometimes knowledge drives away fear.
FILE STRUCTURE
To understand the concept of electronic claim submission, we will compare it to a HCFA form. When you type a form, you have to include certain information such as the patient’s name, address, gender and phone number on the left side of the form. On the right side, you put insurance information, policy number and group number. On the bottom of the form, the doctor’s information appears. Each section of the form gives specified information to an insurance company.
When an electronic file is created, the various sections are divided into records. One record contains the clinic information, another record displays patient data, a third record shows insurance information, a fourth record contains the transactions being billed. A file can contain records and transactions for many different patients and many doctors. When an electronic file is processed by the insurance company, it is comparable to receiving many paper claims. However, there’s one big differenceit takes only seconds to process an electronic file compared to weeks for paper claims.
NSF vs ANSI
At the present time, most software vendors (with electronic capability) transmit claims in National Standard Format (NSF). As the name implies, the files should be identical whether your office is in Georgia or California. In reality, there is nothing “standard” about the requirements imposed by the Medicare carriers for each state. For example, a Medicare file from Georgia has to contain a carriage return every 80 characters (instead of the “standard” 320). A Medicare file from a Wisconsin office has to put the x-ray date and date first consulted in the HAO record rather than using the standard GCO. Is this a nightmare for software vendors? You bet! In an ideal world, a National Standard Format would be “standard.” For right now, vendors have to test in every state. The vendor you choose must know how to accommodate the requirements of your state.
A second method of transmission is American National Standards Institute (ANSI) format. Rumors are flying that Medicare will require ANSI transmission in the future-the rumors are true. The only uncertainty is the implementation date. It is expected that Medicare will require ANSI transmissions by the year 2000, but there has been no official confirmation of this time frame.
CLEARINGHOUSE vs. DIRECT
Once a file has been created, it needs to be sent to the insurance carrier for processing. The method of transmission differs greatly. If you practice in Northern California, you can log on to the internet and send in your Blue Shield and Medicare claims. Since internet usage is doubling every hundred days, it doesn’t take a crystal ball to realize that more carriers will be using the internet in the near future. If you practice in Illinois or Tennessee, you dial the Medicare carrier’s bulletin board and transfer the file. In all of the above examples, one assumption is made: your software accommodates direct submission to the carrier. Because you send claims directly, clearinghouse fees are avoided.
The other method of transmission involves the use of a clearinghouse. Instead of sending directly to the carrier, claims are transmitted to an intermediary. They usually charge between 20 cents per claim to 90 cents per claim for processing the file and sending it on to the carrier. Some software vendors choose to use clearinghouses because it avoids the hassle of accommodating the individual state differences. Quite frankly, there is another reason that no one mentions. Some software vendors recommend a clearinghouse because they collect a “kickback” from the clearinghouse. Every claim sent by their customers indirectly generates revenue for the vendor. Of course, someone has to pay for it! In this case, it’s you, the customer.
PAPER vs ELECTRONIC
The obvious advantage of electronic claims is fast turnaround. I have yet to meet a doctor who complains about getting insurance checks within seven to fourteen days. For Medicare claims there is an automatic fourteen-day hold on claims submitted electronically. If you submit the same claim on paper, there is an automatic twenty-seven day hold from the time it enters the system. Plus, there is additional time for mailing and that is not counting the time it takes for someone to type the form in the first place.
DINOSAUR vs DYNAMO
With the technology available today, you can transmit $10,000 in claims within five minutes or less. Can you imagine how many staff hours would be spent generating $10,000 in paper claims? Dinosaurs did not adapt to the changing environment. Do you, too, want to share their fate?
