Sunday, June 22, 2003

For billers, it's all about service

Enterprise Insight

By Jenny Callison
Enquirer contributor

[IMAGE] Mary Beth Holmes (left to right), Sue Holmes and Ruth Tallarigo of Pro$perity Billing Service in West Price Hill pose in their office recently.
(Gary Landers photo)
| ZOOM |
Three West Price Hill entrepreneurs have learned that a generous dose of integrity, grit and enthusiasm is an effective remedy for physicians' billing blues.

The women, proprietors of Pro$perity Billing Service, provide their expertise to six doctors in private practice. In the 17 months since they formed their own company, they've learned more than just the rudiments of small business ownership: They've learned how valuable their skills and determination are to their clients.

"These insurance companies are devils," said Ruth Tallarigo with a grin. "We try to stay on top of all the changes."

"We like having the control of information in our hands so we can get it correct from the beginning," said her sister, Sue Holmes. "We try to put our emphasis on quality from the beginning so a bill goes out and gets paid quickly. We all care very much about what we are doing."

The two sisters have many years' experience in medical billing. Soon after Holmes began working for a Price Hill group practice in September 2000, she brought Tallarigo in to help her. When they needed temporary assistance, they enlisted their sister-in-law, Mary Beth Holmes. A professional bricklayer, Mary Beth Holmes proved to have an incredible head for numbers. Her temporary stint with accounts receivable became permanent.

"I'm pretty much of a perfectionist," she said. "But I had never touched a computer before."

Then, in late 2001, the group practice dissolved. But Marshall McHenry, preparing to make the transition to individual practice in the same location, was determined to retain the women's services. He persuaded them to start their own firm, guaranteeing them his business and that of another physician in the building. They would continue in the same office space.

"We decided to give it a shot, and officially became a business in January of 2002," Sue Holmes said.

"Cash flow is a problem in any new practice," McHenry explained. "There's always a major delay when you start with a new billing service. I was being totally selfish when I encouraged them to form their own company, because I didn't want to have to start over, and I never wanted to have to learn about billing."

Before the ink was dry on their legal documents, the three women were hard at work securing payment of all the group's outstanding bills, along with the two physicians' new ones.

"It's as if the money belonged to us," Sue Holmes said. "We try to stay with it until we either get the money or decide it absolutely cannot be gotten."

"We're very persistent," said Mary Beth Holmes. "We write off very little."

That's one quality that sets Pro$perity apart from other billing services, McHenry said.

"The competency level of billing services in this city is poor," he said, explaining that many firms simply enter a patient's insurance and medical records into the computer, file for insurance reimbursement of services, and send a patient a bill for what the insurer will not pay.

But insurance companies can decline payment mistakenly, or not pay what they should. Sometimes they change the rules. All that can result in overcharging if accounts receivable workers aren't persistent.

Said McHenry: "Sue and Ruth and Mary Beth have picked apart this really complex system and make stuff happen. They're very competent and very enthusiastic. They feed off each other and communicate well."

"We get excited," Sue Holmes agreed. "It doesn't take much - a payment that's way overdue, or a large payment from an insurer."

The past year and a half have required long days and total commitment on the part of Pro$perity's owners to building their business. They had to buy more computer equipment and increase their online capacity as their customer base has expanded.

Plans are in the works are for more sophisticated Web connections. Pro$perity has struggled with marketing itself, although four new doctors have come aboard solely through word of mouth in the west side medical community.

The firm would like to double its number of customers from six to 12 soon and bring in a few more people.

In addition to growth issues, there's the never-ending matter of mastering the maze of insurance paperwork and medical regulations. In their spare time, the women read professional publications and insurance newsletters to keep up. They then pass along their knowledge to their physicians.

"There is so much to know," Sue Holmes said. "Everything is constantly changing."

Said Tallarigo: "Something will kick out and then you know the rules have changed. If there's a problem, we get on it right away, instead of waiting to see if it happens again."

Both McHenry and the billing service owners say west siders are famous for wanting to discharge debts. That's why it's important to be meticulous, Pro$perity's owners believe.

"We absolutely try, so that if they get a bill, they really owe it," Sue Holmes said.

"They keep things straight, obtain payments in a timely manner, and they're friendly and professional about it," McHenry said.

Making more accounts receivable

Pro$perity Billing Service prides itself on getting charges paid promptly. About 95 percent of their clients' bills are paid within the first 60 days. A new client for whom Pro$perity did initial data entry and controlled the entire billing process enjoys a rate of only 8 percent of accounts that exceed 60 days. Sue Holmes said that this is far better than the industry standard.

At the same time, they will work with patients who have cash flow problems, developing realistic payment plans.

Pro$perity submits claims daily, which added up to about 3,000 electronic claims in May. It processed at least 500 paper claims for secondary insurance carriers during the same period.

Pro$perity Billing Service is at 4871 Prosperity Place, West Price Hill.

Information: 244-4165.


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