They say that any organization, project, idea, or anything is only as strong as its weakest link. That is no more true than in the world of medical billing. The problem is, medical billing has so many weak links in its structure that it is a miracle that anything at all gets done. In this article, we take a look at just a few of these potential disaster areas.

The biggest weak link in medical billing is the system itself. Oh, you can make all the arguments you want about how they’re doing the best that they can with a system that was doomed to fail from the start but it doesn’t change the fact that the medical billing process is a nightmare to begin with.

Let’s start with the billers. Because of all the regulations, a ton of knowledge is needed in order to bill a claim correctly. The truth is, there’s not really a lot of training for medical billing personnel. Most of it is on the job training. As a result, a lot of mistakes are made. Now, in most businesses, when a mistake is made, it can be corrected quickly and no harm done. But in medical billing, a mistake means a claim that goes out with the wrong or incomplete information. This results in the claim being denied. The claim then has to be corrected and resubmitted in order to be paid. While there are no hard and fast statistics on the number of claims that are billed incorrectly, it is estimated that it is somewhere in the area of about 10%. That means, theoretically speaking, each day the workload increases by 10% because of claims that have to be resubmitted. This explains why there is such a backlog on claims that need to be paid. It’s a never-ending cycle, right out of the gate, that’s never going to get any better.

Then there is the inefficiency of the people on the receiving end of these claims. Because the largest claim processors in the United States are from government agencies, these people are not really given the most incentive to do a fast job. So the claim processing process itself, by design, is very slow. This only compounds the problem. But the worst part of it is, the claims that have to be resubmitted are given the lowest priority. This makes it even more critical that claims be submitted properly the first time through.

Finally, as if the above two major problems weren’t enough, you have the problem of poorly designed methods for doing the billing itself. This can range from anything from badly designed software, of which there is plenty, to step by step procedures which are inefficient to say the least. Plus, there is no standardization in the industry itself. Once upon a time, there was only one way to bill a claim. Now you have the standard HCFA 1500 form, NSF 3.01 for electronic billing and UB-92 and other formats as well for the electronic transmission of claims. No two medical billing companies do things the same way.

Experts may continue to debate the merits of medical savings accounts, but there is one thing everyone can agree on: They’re not catching on very fast.

As part of the Health Insurance Portability and Accountability Act of 1996, Congress passed a 4-year demonstration program allowing up to 750,000 Americans working in small businesses to purchase medical savings accounts, or MSAs. So far, only 54,000 have done so, according to the Internal Revenue Service.

Observers offer several reasons for MSAs’ slow start. One possibility is that MSAs are too different from other high-deductible insurance products that are now on the market, said Tom Wildsmith, an actuary at the Health Insurance Association of America in Washington.

For example, individual policies typically have a $1,000/person deductible; if more than one person in a family gets sick in a year, the total deductible will be capped at $2,000 or $3,000. But with an MSA, the family faces a $3,000 deductible even if only one person gets sick, Mr. Wildsmith said.

In general, MSAs allow patients to put several thousand dollars into a tax-free account to be used solely for medical expenses. MSAs are typically paired with high-deductible insurance policies that kick in after the MSA dollars–and any remaining out-of-pocket costs–are exhausted. If any money is left over in the MSA account, patients can use it for other expenses–although they will pay a penalty for withdrawals if they are under 65.

Another problem with MSAs is that they are tax driven, which is common in life insurance policies but not health insurance policies, Mr. Wildsmith noted. “Most health insurance agents aren’t accustomed to talking to their clients about tax planning.”

Robert Laszewski, a Washington health care consultant, said that he thinks patients are turned off by MSAs’ complexity. “They have to keep track of things like whether they should make a claim to the MSA or to the catastrophic insurance policy,” he said.

And the policies aren’t very popular with insurance agents, for good reason, Mr. Laszewski continued. Unlike individual health insurance policies, MSAs are divided into two parts–the savings account and the catastrophic insurance policy–and only the catastrophic policy funds are counted toward the agents’ commissions.

“What did you just do to their commission? You’ve cut it in half,” he said.

Kelly Loussedes, a spokeswoman for the Council for Affordable Health Insurance, an insurer group that supports MSAs, said she blames the slow start-up partly on the way the demonstration project was set up.

“Only three groups of people can have an MSA: [employees of] companies with 50 or fewer employees, those who are self-employed, and those who were reviously uninsured,” Ms. Loussedes explained.

“Once MSAs are opened up [to the whole population], they’ll really expand,” she predicted.

Ron Pollack, executive director of Families USA, a Washington-based consumer group, said that, although he opposes MSAs, he’s surprised they aren’t selling faster. “I would have thought that healthy and wealthy people would find them beneficial.”

In fact, Mr. Pollack and other MSA opponents argue that healthy patients are the only ones who sign up for the accounts, leaving the sicker patients in fully insured plans and causing premiums in those plans to increase.

But Ms. Loussedes noted that more than one-third of those signing up for MSAs were previously uninsured. This lends credence to the notion that the accounts were not being used just by wealthy patients.

“The experience speaks for itself,” she commented.

Most physician organizations, with the exception of the American Academy of Pediatrics, continue to support MSAs. They say that the accounts make consumers more cost conscious and force physicians to become more price competitive.

“We need multiple insurance products to be available in multiple markets,” commented Dr. William Mahood, a trustee of the American Medical Association. “MSAs won’t be attractive to everyone, but we’re not a one-size-fits-all society.”

Bob Doherty, head of the Washington office of the American College of Physicians–American Society of Internal Medicine, said that his organization is taking a cautious approach to MSAs.

“They’re not likely to be a panacea [for the uninsured], but they also aren’t a bomb that will blow up the health insurance system,” Mr. Doherty said. “There needs to be a careful evaluation of what impact they will have.”

And Republican members of Congress appear to be satisfied enough with the results of the MSA experiment that they have put a measure opening up MSAs to all comers into the Patients’ Bill of Rights legislation now being debated on Capitol Hill. President Bill Clinton has indicated, however, that he probably will veto any Patients’ Bill of Rights that includes an MSA expansion provision.

But Mr. Laszewski said that Democrats fears of MSAs wrecking the insurance market are groundless, given how unpopular they have proved to be.

Illinois’ largest medical malpractice insurer announced Wednesday it would reduce its physician policy holders’ average premiums by 5.2 percent for the upcoming policy year.

ISMIE Mutual Insurance Company officials credited recent litigation reforms for “modest” reductions in claims frequency and a relatively flat number of claims.

ISMIE Mutual’s chairman Dr. Harold Jensen was cautiously optimistic. Jensen said even though the results appear promising, other medical liability insurers are not yet flocking to Illinois because they are waiting to see if the reforms will survive if they are challenged by anti-reform groups.

- Neurosurgeons in Cook and Will counties who also are policyholders with $1 million to $3 million coverage limits will pay a premium of $228,484.

- Pediatricians and OB/GYNs in Cook and Will counties will have premiums of $25,088 and $138,484, respectively, said the ISMIE.

The Chairman of ProAssurance Corporation (NYSE: PRA), A. Derrill Crowe, M.D., will participate in the Sandler O’Neill Insurance Equity Conference at the Parker Meridien Hotel in New York on September 13, 2001. Dr. Crowe will be part of a panel that will review the current state of medical malpractice insurance.

The presentation will begin at 7:55 AM EDT and will be available by phone or webcast. The telephone number is (800) 559-9370; international participants may dial (847) 619-6368. The ID number for the call is 4565549.

ProAssurance Corporation is an insurance holding company formed by the merger of Medical Assurance, Inc. and Professionals Group, Inc., two of the leading specialty property/casualty insurance groups in America. ProAssurance is listed under the symbol “PRA” on the New York Stock Exchange.

ProAssurance boasts approximately $2 billion in assets, $495 million in annual gross written premiums, and licenses to write business in over 45 states. The Company is the nation’s fourth largest writer of medical professional liability insurance and one of the 100 largest writers of personal auto coverage. Through its wholly owned subsidiaries, Medical Assurance, Inc. and ProNational Insurance Company, it insures more than 30,000 physicians and other health care risks. ProAssurance also owns 84% of MEEMIC Holdings, Inc., (NASDAQ:MEMH) a provider of auto, homeowners, umbrella, and boat coverages, primarily for educational employees and their families, through MEEMIC Insurance Company.

Major rating agencies recognize the financial strength and stability of the Company’s operating subsidiaries. A. M. Best rates Medical Assurance, ProNational and MEEMIC Insurance Company “Excellent;” while Standard and Poor’s rates the claims paying ability of Medical Assurance and ProNational as “Strong.”

Medical Assurance and Professionals Group were leaders in the medical professional liability industry’s move toward consolidation. Measured either by frequency of acquisition or success of consolidation, each company compiled an impressive track record. Working together, the leadership of the combined companies will build on their successful experience by forming a professional liability group serving the evolving needs of the health care industry.

Choice Hotels International (NYSE:CHH) has entered into a partnership with Star HRG that enables Choice franchisees to provide low-cost medical and dental insurance coverage to their employees.

The agreement between Choice and Star provides limited benefit insurance programs that help with basic, everyday medical and dental expenses. Under Star’s Fundamental Care program, employees receive coverage for physician visits and accidents, prescription and vision discounts, accidental death benefits, and coverage for preventive and basic dental procedures. Some of the plans also include term life insurance.

The plans are available to all hotel employees for as little as $3.45 per week. Premiums are paid by participating employees through payroll deductions or through a stored-value Visa Payroll Card.

Premium collection for the insurance program is fully administered by Star. The combination of insurance benefits and a Visa Payroll Card is an industry first, allowing Choice franchisees to offer employee benefits without any of the typical administrative workload.

“Recruiting and maintaining quality employees is the number one challenge for our franchisees,” said Daniel Rothfeld, Choice’s senior vice president, partner services. “They are constantly looking for tools that give them a competitive edge in today’s tight labor market.

“By providing affordable insurance benefits to their employees, our franchisees have that edge,” Rothfeld said. “Star makes it easy for our franchisees to offer the program. It’s a turnkey solution to one of the most pressing issues in hotel operations - labor recruitment and retention.”

About Choice Hotels International

Choice Hotels International (NYSE:CHH) franchises more than 5,000 hotels, inns, all-suite hotels and resorts open and under development in 46 countries under the Comfort Inn, Comfort Suites, Quality, Clarion, Sleep Inn, Rodeway Inn, Econo Lodge, and MainStay Suites brands. More information is available at www.choicehotels.com. About

Star HRG

Star HRG, a division of The MEGA Life and Health Insurance Company, is a member company of UICI (NYSE:UCI) and is recognized as a national leader in providing Limited Benefit Medical Plans. Star HRG addresses the unique benefit needs of entry-level, part-time, and high-turnover employees by providing voluntary insurance programs, at a price employees can afford. Star HRG’s innovative insurance solutions help companies to reduce turnover, improve recruiting, and stabilize benefit expenses within the hourly paid workforce. More information is available at www.fundamentalcare.com.

Comfort Inn, Comfort Suites, Quality, Clarion, Sleep Inn, Econo Lodge, Rodeway Inn, and MainStay Suites are registered trademarks and service marks of Choice Hotels International.

International Medical Group(SM), Inc. (IMG(SM)) announces the formation of IMG Europe Ltd., a wholly owned subsidiary of IMG. This division will provide marketing services, administration support and emergency medical assistance to IMG’s European insured members from its offices in the United Kingdom.

“We are always looking for better ways to serve our agents and their clients,” said Joe Brougher, President of IMG. “This will enable us to expand and enhance the services we provide to those who are traveling or living throughout Europe.”

The new company will be headed by Ernest Jones. Jones spent many years in insurance before joining the travel insurance industry in 1979 as General Manager of a Jardine Glanvill Company. From 1986 through 1998, Ernie was Managing Director of Mercury International, having co-founded the company. His experience in the travel insurance field and especially the area of international assistance and claims is appreciated throughout the industry.

IMG Europe Ltd. may be contacted at VW2 Maritime House, Basin Road North, Hove, East Sussex, BN41 1WR, telephone: +44.127.338.4926, or fax: +44.127.338.4934.

International Medical Group, Inc. is a worldwide leader in designing, distributing and administering global healthcare benefits. IMG’s international reputation for excellence has been established by providing medical, life and disability insurance products to individuals, families and groups in more than 150 countries.

Since 1990 IMG has served over 500,000 clients worldwide including vacationers, business executives, missionary groups, entertainers, Fortune 500 companies, schools and universities, professional marine crew, expatriates and local and third country nationals. IMG is based in Indianapolis, Indiana. Its companies also include International Claim Managers(SM) which is responsible for overseeing precertification, large case management, and emergency medical evacuation coordination for IMG products. Each of IMG’s companies is committed to meeting the unique needs of its international clientele. For more information about IMG and its products, please call 800.628.4664 or 317.655.4500.

The Centris Group Inc. (NYSE:CGE), a provider of domestic and international insurance and reinsurance products and services, today announced that it has signed a definitive agreement to acquire Indianapolis-based VASA North America Inc. and its subsidiaries and Seaboard Life Insurance Company (USA), from Seaboard Life Insurance Company (Canada) and its parent, Seaboard North American Holdings Inc., a Canadian company that is owned by Eureko, B.V. of the Netherlands.

The majority of the acquired group’s business is medical stop-loss and group term life insurance for self-insured employers. The transaction is expected to close following receipt of regulatory approvals which Centris believes can be obtained within 60 to 90 days.

The group to be acquired includes VASA Brougher Inc., a medical stop-loss managing general underwriter, Seaboard Life Insurance Company (USA) which is licensed in 41 states and the District of Columbia, and VASA North Atlantic Insurance Company, a property/casualty insurer licensed in 36 states and the District of Columbia. Both insurance companies are rated “A-” (Excellent) by A.M. Best Company. The sale does not include Seaboard Life Insurance Company (USA)’s individual life and annuity business, which is being sold separately.

Acquisition solidifies Centris’ leadership

position in medical stop-loss business

“This acquisition not only strengthens our position in the medical stop-loss business, but also brings a widely licensed life insurance company into our group. This will allow us to leverage our capital more advantageously, and will provide synergistic opportunities for other companies in our group like INTERRA,” said David L.Cargile, Chairman and Chief Executive Officer of The Centris Group.

VASA Brougher is believed to be the fifth largest provider of medical stop-loss coverage in terms of annual premiums generated. Prior to this acquisition, Centris’ USBenefits subsidiary was already the leading provider of medical stop-loss coverage in the country. VASA Brougher’s operations will be integrated into Centris’ existing operations, giving Centris access to its distribution system which is particularly strong in the Midwest.

“This strategic acquisition is a move forward in terms of strengthening our leadership position in the medical stop-loss business,” said Cargile. Centris indicated its medical lines revenues are expected to grow by approximately 15% to 20% as a result of the acquisition. “We believe that by focusing on medical and other specialty lines, we can achieve the most efficient use of our capital base,” added Cargile.

Centris indicated that the purchase price for the group will approximate the statutory book value as of the closing date of the insurance companies being acquired. Centris also indicated that as part of the transaction the sellers have agreed to provide protection for adverse loss development on the acquired group’s existing business. Other terms of the transaction were not disclosed.

Company exploring best strategy for property/casualty lines

As previously announced, Centris recently retained Advest, an investment banking firm, to explore strategic alternatives for its property/casualty insurance lines, which generated $47.3 million in gross premiums written for the six month period ended June 30, 1998. Statutory policyholders’ surplus for Centris’ insurance companies at June 30, 1998, was $117.7 million. Among the alternatives being considered is a possible sale of Centris’ property/casualty operations.

About Centris

The Centris Group Inc. operates complementary businesses based on its expertise in the handling of specialized risk. It is a market leader in medical stop-loss coverages that produce revenues from both premiums and fees. Centris is also a provider of property/casualty reinsurance, excess and surplus lines insurance, special risk accident and health insurance products and reinsurance intermediary services. Other specialized risk operations include claim review, premium and claim auditing, prospective program review and runoff management.

Among the most highly rated companies in its markets, The Centris Group conducts business both nationally and internationally through USBenefits Insurance Services Inc., USF RE INSURANCE COMPANY, USF Insurance Company and INTERRA Inc. Centris’ insurance operations are rated “A” (Excellent) by A.M. Best Company and USF RE is assigned a claims paying ability rating of Aq (Good) by Standard & Poor’s.

Forward Looking Statements

Some of the statements included within this release which are not historical facts may be considered to be forward looking statements within the meaning of section 29A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, and therefore are subject to certain risks and uncertainties which could cause the actual results to differ materially from those suggested by such statements. Such risks and uncertainties include, but are not limited to the following: catastrophic losses in the company’s insurance lines or a material aggregation of such losses; changes in federal or state law affecting an employer’s ability to self-insure or other adverse regulatory changes; the adequacy of the company’s reinsurance program; general economic conditions in this country or abroad; adverse developments in the securities markets and their impact on the company’s investment portfolio; the effects of competitive market pressures within the medical lines or property/casualty marketplaces; the effect of changes required by generally accepted accounting practices or statutory accounting practices; and other risks which are described from time to time in the company’s filings with the Securities and Exchange Commission. The words “believes”, “anticipates”, ” expects” and similar expressions are intended to identify forward looking statements.

When considering becoming a medical billing specialist, you must consider the skills and abilities required. Knowing what you are looking for, making the right decision as to which medical billing specialist area you want should become fairly obvious. Take a look at what a medical billing specialist should be familiar with and what they have to do so that you can choose the right medical specialist area.

In order to become a medical billing specialist, and work from home, you should make sure you understand medical transcription and be able to use medical billing software. Medical transcription is the transferring of medical information from audio recordings to either paper or electronic format by means of medical billing software. As a medical billing specialist you should be aware of this because of the information contained in the transcripts. Data which is transferred becomes the electronic medical record which shows how much everything the medical billing specialist works with is interconnected.

Medical transcription is usually outsourced to a third party, typically one who will work from home, and is done through the use of medical billing software. Each part of the process should be overseen by someone who has been trained to do the medical transcription as a medical billing specialist.

Also as a medical billing specialist you must be familiar with the various medical codes. In addition you should know about record keeping, billing, and certification as well as understand the medical billing software. This allows you as the medical billing specialist to be familiar with the important standards that control how a medical billing specialist actually performs your job. Knowing this information is crucial if you want to be a good and an effective medical billing specialist.

For companies deciding how to choose a medical billing specialist is not easy. They must have an understanding of what all a good billing specialist knows and understands in order to make the proper selection for their medical billing specialist. The information above should help you get a feel for and understand what you should know when choosing to become a medical billing specialist.

There are many Medical Billing and Coding Classes to be found if you look. Choosing one that provides you with what is best for your career prospects requires in depth research. In this article, you will discover the 5 steps to look for when considering a Medical Billing and Coding Class

Step 1 – Where to carry out your studies

You can choose to study at home via correspondents, or at an establishment. The right choice for you will obviously be one of time constraints. If you are in full-time employment and cannot afford to take the time out to attend a Medical Billing and Coding Class, then home correspondent Medical Billing and Coding Classes is the obvious way to go.

Step 2 – Make sure you can commit to the study time

The average study time required for qualification in a CCA Medical Billing and Coding Class course is in the region of 300 hours. You need to make sure before you start the course that you won’t be stretched too much time wise. You need to make a commitment to see it through, and stick to it. If you do, then your chances of success will rocket, and stress won’t take the better of you

Step 3 – Make sure the Medical Billing and Coding Class you take include the following It is important to ensure that the Medical Billing Classes cover certain aspects. You should at least cover the following: -

Foundations of Medical Terminology

• English 101
• Medical Words
• Dynamics of Medical Vocabulary and Word Structure
• Body Dynamics
• Medical Instruments and Equipment
• Questions and Exercises
• Medical Specialties and Specialists
• Diagnostic Medicine
• Abbreviations
• Anatomy and Physiology
• Pharmacology
• Case Studies

Billing Principles and Regulations

• Who Pays and Who Benefits?
• Provider Structure and Protocols
• Hospital Billing
• Practice Economics
• Collections
• Medical Coding Systems
• Fee Profiles
• Overview of Medicare/Medicaid

Billing the Health Insurance Company

• Health Insurance Specialists
• Understanding the Terms
• Healthcare Organization Plans
• Insurance Claims
• Payer Processing
• Laws, Rules and Regulations
• Private Insurers
• Medicare
• Medicaid
• Tricare

Step 4 – Stay motivated

Remember, you are taking Medical Billing and Coding Class because ultimately you want to enhance you prospects. One of the biggest killers and routes to failure is lack of motivation. If you keep in mind the following information, you will keep the reason why you started the Medical Billing and Coding Class in the first place, and it will help you stay focused and motivated.

As a qualified professional, you enter in to one of the fastest growing professions in the U.S. Certified Medical Billing professionals are in high demand throughout the healthcare industry. In fact, according to Healthcare Jobs.org, Medical Billing is one of the fastest growing opportunities in healthcare. Insurance companies and government agencies are spending more time and money researching and controlling claims fraud, abusive practices and medical necessity issues. Because of this, most companies and practices are looking for employees who are highly trained in the field. And, studies show that Medical Billers are paid accordingly for their skills. The average starting pay for a certified Medical Biller is about $35,000+ per year, with experienced Medical Billers making well over $50,000 per year!

Step 5 – Enjoy your studies – Be positive

Studies can become a chore, and a Medical Billing and Coding Class is no different than other studies. However, if you maintain a positive outlook, you should be able to enjoy the studies, and as a result you will get the major long term benefit. If however, you fall in to the trap of forming a negative attitude, then your studies will become tedious, and your desired success may suffer.

Medical billing doctors play a significant role in medical billing business. Many medical professionals run medical insurance billing services as a side business.

Medical billing doctor’s is a profession that combines the job of a doctor and a medical insurance billing professional. Even though, healthcare industry is well established in America, most healthcare providers, especially doctors, have no idea about how to make quick money. Furthermore, health maintenance organization (HMO) and many other insurance companies have reduced remuneration rates to healthcare professionals, and as a result, many doctors have to search for new revenue sources such as medical billing and seeing patients in large volume. They consider medical billing as a convenient means to get paid more. Medical billing doctors offer you services such as claims management, patient billing, receivables management, electronic processing, payroll management services, and receivables management.

As medical insurance billing professionals, doctors also carry some responsibilities. They have to check and send the patient’s claim form out to the medical insurance company, and make sure that all the information is correct.

Medical billing doctors need to be well informed on various medical insurance plans, which help them treat their patients according to the best insurance plan. As a medical billing agent, a doctor has to play a more active role in office administration. Doctor’s electronic billing services and many online medical billing services assist them in easy processing of patient claims. Lots of medical billing software packages assists doctors in creating patient statements, reprint overdue claims and statistical practice management reports, and electronic billing claims within seconds.