Medical billing trouble spots

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Presenter: Neal
Guest: Karen Moulder
Guest Bio: Karen Moulder was the first woman to be hired in the Brownsville, Texas Fire Department in 1983. Her tomboyish nature and single mother circumstance led her to this fascinating and dangerous career which lasted a little over ten years. Her career involved protecting lives, property, and educating the public on fire safety. She entered a man’s world back when few women did and became a role model for other women. Karen went back to college and majored in business after a car accident ended her firefighting career. She went on to work managing a physician’s office where she obtained her certification in medical billing. She later moved across the country from Texas to Massachusetts where she started her own medical billing company. She now lives there with her five children and two grandchildren. Her Book is entitled “Burning Barriers”

Segment Overview

Karen Moulder talks about some of the problems associated with medical billing and coding that affects patients and physicians alike.

 


Transcription

Health Professional Radio

Neal Howard: Hello you’re listening to Health Professional Radio. I’m your host Neal Howard, so glad that you could join us today. There are a lot of changes that are taking place in all aspects of the medical profession – doctors, EMTs, pharmacists, you name it. If it has to do with the medical profession, the new healthcare act, The Affordable Health Care Act is going to impact it greatly. Our quest in studio today Karen Moulder was the first woman to be hired as a firefighter in Brownsville Texas back in 1983. Knocked down walls of discrimination and affected change in the fire department there. However an accident changed her life and her outlook as well, causing her to change careers. She is now a medical billing specialist in the state of Massachusetts. How are you doing today Karen?

Karen Moulder: I’m great. How are you?

N: I’m doing well, thanks for returning with us. As a medical billing expert, you were in well basically the medical field from the beginning as a firefighter. You’re involved in first responding to accidents, things that maybe had nothing to do with the fire per say but you were versed and skilled in first aid, first responding, resuscitation, all sort of things medical. And an auto accident changed your life both physically and emotionally as it pertained to your firefighting career. You’re now a medical billing expert having managed medical practices in Texas and in Massachusetts. You’re running your own business now, am I correct?

K: Yes, I am.

N: Well what exactly is medical billing and how does it differ from any other type of billing?

K: Well basically, whatever the doctors do it has to be put into code in order to send it to the insurance companies for reimbursement.

N: Okay, if I can interrupt just a moment. Now you say everything that the doctors do has to be put in code for them to get paid. Why isn’t it just as simple as “Hey I had an x-ray. It’s this amount of money, here you go.” What are you talking about when you’re talking about codes?

K: Well they have a set of codes set up for basically everything that is done to a patient and then they have another set of codes. Well those codes are called the CPT codes and they have another set of codes called ICD-9 which are basically diagnosis codes, and those are the diagnoses that the doctor when he treats a patient. Because there are so different diagnoses and there are so many types of treatments, it just goes over faster for reimbursement of payment to the insurance company. So they have set up coding system that has to be sent over to every insurance company in order for the physician to get paid.

N: Now as far as these codes are concerned you can say they’re sent over to every insurance company. I’m going to assume that theses codes are universal, they’re not different if you’re billing one company as opposed to another, is that right?

K: Yes they’re universal and that every insurance company goes by those guidelines.

N: Now is this something that has always been in affect? When did medical billing using codes come into effect?

K: I’m not sure but I know back when I first started, it’s been there since then. So I’m not a 100% sure when it exactly started.

N: Okay so we’re talking at least 20 years.

K: Yeah, 20 plus years.

N: At least 20 plus years that they’ve been billing by code. Had you ever been involved in any type of billing before, let’s say when you were a firefighter was there any hands on administrative work that had to do with billing?

K: No, I didn’t have to do any of that. I know that the ambulance companies did that because they’re the ones that were with patients. We dealt with patient on the other end by helping them, and treated them, but now on the other side, trying to help get payment for those services.

N: Now if I can ask you a question, it goes back to you firefighting days – if you respond to an address and you perform CPR or you get there and maybe well somebody that had a fainting spell or whatever – are your services ever billed to a company or is it all public service?

K: Fire department’s side is service, whereas if an ambulance responded, they would bill to the insurance company for their services.

N: Okay, so if you respond to my residence, I’m not going to be billed by an insurance company. However the ambulance that arrives and maybe has to take me or a family member to the hospital, they will be using this coding system that you talk about in order to billed my insurance company.

K: Right.

N: Okay. What got you into specifically medical billing? I understand that you were managing a practice for your brother-in- law and then you were involved on the hospital side, a much larger practice. But you were still in the management role and I guess billing was just one aspect of that management. How did you narrow it down to medical billing specifically for you?

K: Well when I was working for my brother-in-law, he had sent me to get my certification in coding. So I’ve always have an interest in it since then but I kind of got away from it with managing the practices and getting involved in what’s required in a medical practice. And then I think when I went back towards teaching those doctors and the staff how to use the medical billing software, it got me kind of interested in it again and then just going, honestly just being in that business alone it made me open my eyes to see how many medical practices hire people who don’t know what they’re doing. It’s really sad to say that but they did, they would hire people that didn’t know what they we’re doing and they’re not making the mistakes they would make you know losses money for the doctors. So it’s just kind of got me like back into it because I just did enjoyed the coding and being able to bring in the correct reimbursement for the physicians.

N: And the sense of a job well done as opposed to watching those around you kind of piece … it together and accept for mediocrity, and also damage the finances of the doctors. A lot is being said about the complexity of the new healthcare law as it pertains to the payouts to physicians. Now you being a medical billing expert, surely you’ve got to really be on your toes and have all your I’s dotted and your T’s crossed when it comes to medical billing now especially.

K: Oh, yeah it’s very intense. I know when I first started learning it, I used to think “Can I just put a chip in my brain because there just so much to learn.” And the problem with it is not just learning it, is that it changes every year. So you have to always be learning and be on top of it and now with all the new healthcare changes, Medicare’s guidelines are getting so much more strict where we actually have doctors that are actually quitting as doctors and going into something else or retiring early because they don’t want to go by the more strict guidelines that are being imposed on the doctors.

N: So if I’m hearing you correctly you’re saying that the new healthcare law is so, I guess complicated, that doctors actually leave the profession that they spent, I don’t know 20 years of school preparing for and practicing and it’s that muddled… is that system?

K: Well there’s so much, it’s so intense that they have to hire so many people just to get through all the paperwork and all the requirements that they’re imposing on them that it’s getting to the point where it’s really starting to affect, honestly it’s starting to affect the care of the patients. Because the doctors are so worried about dotting their I’s and crossing their T’s that they’re not giving as much time to the patient as they should because they have so much other stuff that they have to report back so that they don’t get fined or they don’t get like Massachusetts has a law now that if they don’t … because Medicare wants us to go over to electronic medical records. So they have to do everything on electronically now instead of the old paper files. And I think Massachusetts is the only state right now that says “If you don’t switch over to that by 2015, you’re gonna lose you license.” They cannot use paper charts anymore and hand write anything, it all has to be done electronically and that has to be implemented and done by 2015 or they will lose their license. And as far as I know that they’re looking for try, get that changed like now this year because there’s still about 17,000 doctors in the state of Massachusetts that have not gotten changed over to the electronic medical records.

N: Well do you think that with having to hire so many people to keep things straight, you’re hiring this people to keep things straight and just paying them to keep things straight takes away from your bottom line anyway?

K: Well yeah, the doctors are having to spend more money in staff, they’re having to spend more money in these electronic medical records, programs and computers and IT people and there just so much money involved in trying to meet all these requirements that they’re imposing, it’s that what I say the doctors are looking to move on because the reimbursements are going lower, the reimbursements and payments from their services are going lower and the cost to run a practice is going up.

N: Now as we wrap up, you founded Claim Check Billing there in Massachusetts. How long have you been the owner of your own business?

K: I have had my business for 10 years now. It’s over than 10 years.

N: So you’re well established with a great client base and lots of trust in your expertise, yeah?

K: Yes, I do.

N: Now obviously there is not as much I guess action, even close as you were seeing on a daily basis as a firefighter. How has the transition affected your relationship with your kids? I remembered you talking about being close to your oldest daughter and your grandkids, moving you moving to Massachusetts. Do they see this as a much safer occupation or is there like a sigh of relief that you’re out of the fright?

K: Oh of course because I actually have an office within my home so I work out of my home. And I actually my oldest daughter work for me now.

N: Great.

K: So we get to see each other more often. And it’s like you said and since I work at my home, I don’t have the travel either so I don’t have to deal with that (chuckles).

N: Great.

K: So yeah, it’s way safer that it was in the other field.

N: And if you love what you’re doing, it’s never a job, right?

K: Yeah, it is. It’s a great job.

N: Great. You’ve been listening to Health Professional Radio. I’m your host Neal Howard. We’ve been in studio today talking with Karen Moulder, the president and CEO of Claim Check Billing. We’ve been here talking about her transition from the life of a firefighter to the life of an office manager in the medical field and from that transition, into running her own company in medical billing. Talking about some of the hardship that she’s encountered and some of the stress that it puts on our medical professionals as they try to keep up with the sweeping healthcare laws and regulations. It’s been great having you here with us today Karen.

K: Thank you for having me.

N: Transcripts of this program are available at hpr.fm and also at healthprofessionalradio.com.au.

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