• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Collecting for Care: Business Helps Doctors By Managing Insurance

Posted on: Monday, 16 January 2006, 21:00 CST

By Jane Roberts, The Commercial Appeal, Memphis, Tenn.

Jan. 16--Marlene Wright is out there swinging for doctors, filing their insurance claims and staying on the case until they get paid.

In an age of unrivaled Medicare cuts, you might say she's taken on the dragon and made a home in its scales.

"I have a vested interest. If my doctors don't get paid, I don't get paid," said Wright, president of Medical Insurance Filing Service Inc., the company she started 26 years ago.

Today she and her 31 employees manage insurance claims for 48 physicians in 18 clinics across West Tennessee, "advocating for doctors," Wright said, "when a lot of times they are getting less than what you'd pay a plumber to come out and fix your toilet."

"It used to be you could submit a $450 bill and the whole thing would be paid," Wright said. "Not any more."

Under the rubric of Medicare and health care reform, the system of filing and getting paid now means physicians must contract with insurers on a fee-for service basis or risk losing an entire group of patients.

Certain diagnoses warrant only certain procedures, making it tough to get reimbursed for cardiology screenings -- for instance -- if the final diagnosis came back as a urinary infection.

"We send the paperwork back to the doctor and request further documentation," Wright said.

"It may very well be that the heart tests will be paid for, but we need to go back further in the diagnostic process to show why."

Nationally, the increases in health care spending have tapered for two consecutive years, according to a report from the Centers for Medicare & Medicaid Services.

The growth dropped from a 9.1 percent increase in 2002 to 7.9 percent in 2004 when Americans spent $1.9 trillion on health care or $6,280 per person.

"While the figures demonstrate that we may have begun to turn the corner on health care costs, these trends are still not sustainable over the long run," said Joe Klein, president of the American Benefits Council.

"The answer lies in better aligning cost with the quality of care."

And while doctors have always known that billing is central to their business, "it's not where the office is focused," Wright said.

Ken Beasley, CEO of OrthoMemphis PC, and onetime head of Baptist Memorial Hospital-Memphis, agrees.

"There's a lot of commonality but as much dissimilarity among plans, and you have to remember the rules for each, and they vary not only by company but by diagnosis."

Companies that do the work reduce the doctor's risk of embezzlement, he said, because they deal less with live cash and have built in checks and counterchecks for dealing with cash.

The other benefit, he said, is "if you a problem one client is having, chances are it's happening in other doctors' offices but they wouldn't know because they are sitting in isolation."

Medical Insurance Filing is one of the largest private medical billing companies in Memphis. In 2005, sales were $1.3 million.

"In 2006, I would hope we'll see $1.4 million," Wright said.

"This is a hard industry. Medicare sets the standards, but most insurers follow suit."

-----

To see more of The Commercial Appeal, or to subscribe to the newspaper, go to http://www.commercialappeal.com.

Copyright (c) 2006, The Commercial Appeal, Memphis, Tenn.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: The Commercial Appeal

More News in this Category