How To Handle A Bounced Check From A Patient

More and more patients are bouncing checks more than ever because of the economic situation.  It’s really important to focus on prevention and also to have a plan in place if you do receive a bounced check. 

Having a financial policy in place is a good start.  Right away patients know their responsibility and they are also informed of the consequences of violating that policy.  The policy should every so often be updated and every time there is a change, the patient should sign the new policy upon arrival for their appointment. 

The staff should also be active in efforts to make sure patients pay their bills.  They need to be well trained and keep the lines of communication open about the financial policy.

It’s important to copy the patient’s insurance cards and driver’s license when they first arrive to the office front desk registration.  Having the patient’s driver’s license helps to identify the patient and also it shows the correct address of the patient, which should be matched up against the address on the check.  If the address does not match, it would be wise not to accept the check.  Accepting company checks is something you may want to avoid also because a company is usually a protected entity, so if the check were to bounce then the practice has very little recourse when trying to collect payment from that patient.

The financial policy should also include what the consequences are when a check bounces.  If there are bank charges, make sure the policy indicates that the patient will be responsible for those charges.  A good website to see what laws for each state is  This website is the National Check Fraud Center and it lists bad check laws.  Also in the financial policy it would be helpful to reference the laws straight from the website itself. 

Consider using a check-scanning system from a company that guarantees that the check has been cleared.  The money is immediately deposited into the practice’s bank account and there is no need to visit the bank with a paper check for depositing.  Common reasons why a check is bounced is due to insufficient funds, closed account, stop payment or because they have been forged.  When any of the above situations happen, it’s good to investigate to determine if this is the case and also making a phone call to the patient and document the phone call.

If a patient bounces a check and the check is settled eventually by the patient, it’s a good idea to convert the patient to self-pay by cash, credit card or debit card.

These few steps can help to recover and prevent checks that have bounced and keep the cash flow going.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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A Brief Guide on Documentation and Coding

A provider has the responsibility for making sure that the correct level of service was provided and the proper code was used for billing.  This duty cannot be passed on to someone else.  The physician provided the service, they have to decide what to bill.  They know better than anyone what services were provided. 

The first step is to decide what the diagnosis is.  An ICD-9 code is then used to describe the diagnosis (soon to be ICD-10).  The next step is to code the treatment by using a CPT code.  Which describes the treatment the patient received or the visit that took place.

A common misconception is that downcoding can help avoid audits.  Unfortunately, not only is that not true but it cheats the physician from receiving payment for services they deserve.  So it’s important for providers to document their services accurately and keep track of the time they have spent with the patient in order to be able to bill for the proper services rendered.

Some physicians are hesitant to use a new CPT code because they rationalize that the insurance company won’t pay for it.  It’s just the opposite, if the insurance company sees that a certain code for a service is not being used often, they may be less likely to cover it.  If the physician feels this way, for their sake it’s important to have good documentation to justify using a new code or any code for that matter.

It’s important to evaluate what sort of impact your coding will have on your patients.  In some cases, if a particular code is not paid for, the charge will be passed onto the patient.  Billing a particular CPT code or “-25” modifier may be justified, but it also could cause a problem if a large portion of your practice complains about having to be responsible for these charges. 

A practice that keeps up to date with coding changes and who follow proper coding procedures will do well overall.  Changes happen all the time and if the person handling the physicians billing is not up to date, it could cost the practice a lot of money.  Attending coding seminars, commercial resources online or subscribing to newsletters is helpful in keeping up with the changes.  Some practices or healthcare providers who are in a large group still have to be mindful of coding procedures and not just rely on those who are doing the actual billing. 

Physicians should have clear knowledge and understanding of billing and coding practices in order to be able to be the most accurate and precise as possible.  Having good communication with the insurance biller is also key to correct and accurate billing.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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Tips For Running A Productive Medical Private Practice That Thrives

Running a thriving private medical practice can have its every day challenges.  There are quite a few aspects of running a practice that contribute to keeping your staff and yourself productive.  One of the first issues is your staff.  Having a good staff can mean everything to an efficient practice.  It’s important to hire friendly, reliable and resourceful people to help run your office.  Understanding your staffs strengths and weaknesses is important in order to optimize the work flow. 

Having an office manager can help to relieve the physician from every day office issues and endless paperwork.  It’s also an advantage to “cross train” your employees so that each staff member is interchangeable in most aspects of the office if it gets really busy or if a staff member is out of the office for a period of time.

Another important issue is having an onsite biller or an offsite billing service to handle all the insurance claims and patient accounts.  A good and qualified biller is key to a productive office.  A good relationship with your biller is crucial.  A physician who is running a private practice needs to know how to bill.  Physicians didn’t realize when they were in medical school that they would become a small business owner.  In reality, that’s what physicians become whether they like it or not.  So it’s important that this is a priority when starting a private practice.

Have quarterly promotional events at your office.  Become involved with your local community, for example with the local chamber of commerce.  Get to know other physicians in your area.  A strong relationship is more fruitful and beneficial for your patients.

Another area to concentrate on is the cleanliness of your office.  Nothing is worse than walking in as a patient to a dirty and messy physician’s office.  Patients want to feel welcomed and comforted by the environment they are in before they see the physician.  A professional cleaning company is a good idea to have in order to keep the office looking clean and welcoming.  Their also should be staff members assigned periodically to check the restrooms to refill the soap dispenser, toilet paper and any other paper products.  A sign should also be posted in the restroom the importance of washing your hands after using the facilities.  Most office’s close at lunch time and that would be a good time to straighten up the waiting room from the mornings patients.  This area should also be checked throughout the day. 

Doing small things such as these can make a world of difference to your practice and more importantly the patients will feel that they are in good hands and are valued.  Happy patients mean more referrals; here’s to your thriving business!

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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Electronic Medical Records Part II

As was discussed in part one of this article the risks of using the technology of electronic medical records shows many things that physicians should be aware of and also how to reduce legal risks.  We will continue on with this article with five other ways to reduce these risks.

6.  Physicians should make sure to sign off the record or log out of the system

This practice is extremely important so that if a physician does not sign out and another physician continues under his or her log in name.  This can create a problem because the bill could be submitted under the wrong physicians name.  If this were to happen an insurance company can ask for a refund of payment if a medical record is submitted during an audit.

7.  Understand how the system records who is accessing and writing in the record

There should be a system in place where if one is accessing the record but after a period of inactivity an automatic time-out occurs.  If a physician needs to make changes or add to a record this should be done at the end of the day but there should be a time period in which the record should lock.  In the case of changes being made, a new entry should be noted and it should be clearly written as an addendum to the record with the date of which this change or addition was made, the reason why the change or additional information was added and also at the end of the entry should be an electronic signature to verify the person who made the changes.

8.  Print out a note from time to time to be sure your entries are in your name and record the time of the medical record entry

 The past some physicians have had the habit of entering in the patients record in the era of pen and paper method, to record things that haven’t happened yet.  One example could be that a physician records a date of a cesarean section but that actually hasn’t happened yet.  So this would have to be entered as a notation with the actual date of when it was entered instead of in the future.

9.  Make sure that only appropriate staff members have access to the records

There should be a protocol in place in case of a security breach from a staff member or other person.  There should be a password that is protected when the person or persons that have authorization to log in.  Having an automatic sign-out feature is also a protection in case the physician should forget to log out.

10.  Protect records from inappropriate viewing by setting up screensavers and require a password for reentry

Having this feature helps if ever the laptop or computer is left in a room unattended.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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Electronic Medical Records Part I

Electronic medical records are currently the new trend that most physicians are heading towards.  This practice has been a way for physicians to improve the care of patients, reducing costs and to avoid medical mistakes.  On the other hand this new technology may come with some legal risks. 

There are many benefits to using a system of electronic medical records which include being able to read the record without having to worry about sloppy handwriting, immediate access to the records, built-in safety features and also it would reduce the risk of a physician prescribing a medication that the patient is allergic to.

However EMR’s may create some problems.  Some physicians could be sloppy typists and the fact that some physicians will most likely take home the laptop and that poses a problem with the patients confidentiality which could result in a HIPAA violation.  So with this in mind it’s good that physicians or any other healthcare worker that has access to patient records pay attention to the risks that are important to consider.

Here of 5 of the 10 ways to reduce legal risks.

1.  Implement personal and practice policies regarding electronic order entry

Be careful when reading messages from the system.  If there is a multitude of emails being sent often, unsubscribe these unnecessary emails.

2.  Develop a system and policies of what to do when an order occurs when the physician is not at his or her workstation or if the system is temporarily down

There must be in place a system of how to handle this situation if it happens.  For a period of time, physicians may have to go back to pen and paper to record important information for the patients record and later enter that information into the electronic medical record.

3.  Print out progress notes from time to time and evaluate the accuracy of the record

These records should then be evaluated to see if they are easy to follow and read.  They should also be evaluated to see if the record accurately show what the physician did for the patient.

4.  Back-up the records.  Make sure to check the back-up method frequently. 

It’s important to make sure the files are backed up everyday.  If a physician fails to do this, they could possibly lose patient records and have no other way of showing what the physician has done for the patient and also no documentation in the event the physician is sued.

5.  Install virus protection software on server and workstation computers

This is extremely important to install on the computers that are being used for electronic medical record technology in order to avoid a virus infiltrating your system which could be very damaging.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

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Things To Consider When Using An Outside Billing Service

It’s very common for physicians that have a small private practice to a mid-sized group of physicians to feel overwhelmed by paperwork in order to process their billing.  Many physicians now are considering using an outside billing service to handle all of their claims.  It’s good to make sure the person or company you decide to hire has a back-up system and can also handle your billing in a timely manner. 

Important Requirements

Bill only for services rendered

Claims should be correctly coded for services performed

All bills should be submitted in a timely fashion

EOB’s should be read and checked for proper payment

Late payments from patient’s should be follow up on and monitored frequently

Patient’s should be made aware of charges that may not be covered

Charges that were not covered or co-payments should be collected from the patient’s

Provide monthly reports on the status of claims submitted for payment

Before an account is turned over for collections, it should be discussed with the physician first

Complying with HIPAA


A written agreement and contract should be signed and clearly identified within the agreement before signing. Just because the physician decides to use an outside billing service does not relieve them of the responsibility of complying with HIPAA.

Selecting a reputable outside billing service

When selecting an outside billing service it is good to do your homework.  One way is to ask your colleagues for recommendations.  Ask for their references and talk with them.  Below are a some key questions to ask potential outside billing services.

Do you have a written compliance plan?

What billing system do they use?

Can the software they use be networked with the office so that the physician can view billing and collection data?

What are the security and access features to assure HIPAA confidentiality compliance?

Does the system being used have a back-up system that can retrieve information if the computer fails?

Does the billing service educate the physician about accurate coding to get maximum reimbursement for services rendered?

Finalizing the contract agreement

Once you have made your decision on the billing service you intend to use, make sure there is a written contract.  The contract should detail exactly what services you are to receive for the fees agreed upon and also list what services are available for additional fees.

The contract should also include renewal, dispute resolution, and cancellation terms.  If you feel uneasy at first, set a short-term agreement so that will give you time to find out whether you feel comfortable with the billing service and you can test out their service without being held up into a long term contract.

Are Physicians Earning What They Deserve?

Due to the constant rising costs in insurance coverage and rising overhead costs, many physicals are starting to wonder if they are earning what they deserve.  A study was done by the internet site Medscape which received over 15,000 responses from doctors from 22 different specialties to hear what these physicians have to say. 

In one aspect of the survey it compared what men versus women earn.  The study showed that men earn more and it was due to them putting in more hours.  Most of the women studied said that they chose part-time or shorter hours in order to be able to spend time with their families but also still have a career. 

One area of specialty that seemed to love their jobs the most is Dermatologists which had an overall satisfaction score of 80% and even more interesting is that they would chose the same specialty if they had to do it all over again. 

Primary care physicians had the lowest overall satisfaction score of only 54% and when asked if they would choose this specialty again only 43% said they would.  Pediatricians and primary care physicians are key in the overall success of healthcare reform.  These specialties should be of paramount importance to keep them well paid and be satisfied with their career choice.

The specialty that showed they earned the most was Orthopedic surgeons and radiologists.   The study showed that these two specialties earned a median income of $350,000.  The lowest paid physicians where pediatricians which earned  $148,000 median and primary care physicians earned $159,000. 

Another aspect of the study compared private practice versus employment.  This showed that doctors that have their own private practice earn more than employed doctors.  Physicians that have their own private practice earn a median of $275,000 and hospital employed physicians earned a median of $200,000.  Even though physicians that have their own private practice earn more than employed physicians, they still feel less fairly-compensated.  This is most likely due to working more hours and they have to contend with insurance carriers, staff issues and office expenses which can cause stress because they always have to worry about ways to attain a steady income.

Physicians in a private practice may think that being employed will free them from hours of administrative duties and they may have more freedom and time.  On the other hand, employed physicians have to attend meetings and creating reports.  Most employed physicians also have to spend a great deal of time with paperwork and other tasks related to their position.  All these facts are definitely something to consider when deciding to set up your own private practice or to be employed.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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