Medical Billing Data Conversion: Transferring the Client's Data Into Your System

Full Blown Data Conversion
A "full blown data conversion" means that you would be gathering all of the patient data (demographics and transactions) and loading it into your system prior to beginning the billing process for your client.  This can be accomplished either manually (adding each patient by hand) or by hiring someone to convert the data from his software to yours.  Handling this manually can be brutally time consuming, depending on the size of the practice as well as extremely frustrating due to missing and inaccurate data.  Hiring someone to convert the data can be very expensive as well as time consuming, and disheartening when you find that the data has been entered sloppily into their system and you too end up with a sloppy system.  I would much rather enter all of the data myself as opposed to "filling in the blanks and correcting the mistakes" of existing data.  Also, existing data contains patients who are inactive and/or carrying uncollectible balances, which just takes up unnecessary space in your software program.  I tried the "full blown" manual conversion just once, with my first client, and decided that there had to be a better way.
 
Another important lesson that I learned was that there was a reason why my client needed me to handle his billing ----  and for me to expect that the information being provided to me from his existing practice management/billing system was accurate, would simply be naïve on my part.  Garbage in...   garbage out.

I would not recommend a full blown data conversion.  There is a better way.

Gradual Data Conversion
I compare a "gradual data conversion" to "burning a candle at both ends."  You speed up the process and can look forward to the flames meeting in the middle (which means the conversion is complete).  You are able to begin the billing (and your income) and perform the conversion at the same time.

To perform a "gradual data conversion", you and your client would agree to a "start date" (which should be clearly defined in your contract).  The start date would be the day that your client begins sending you all patient data required to perform the billing for a complete days worth of services.  All patient's, data-speaking, will be treated as a "new patient." 

The criteria you require to process a new patient for billing are patient demographic

 information (Patient Information Form), Insurance Information (copy of front and back side of insurance card), Insurance Verification Form, Charge Information (CPT), Diagnosis Information (ICD9).  On the "start date", if the practice sees 10 new patients and 10 existing patients, you should expect to receive "new patient information" on all 20 patients.  Also, since you will need to record an accurate account balance for existing patients...   all existing patient information should also include "transaction history information."  It's wise to have the client's staff member who is responsible for gathering existing patient data, to place a "marker" on the existing patient's file folder, indicating that the reports you need have been sent to you.  A sticky, colored dot on the outside of the patient's folder with the date the records were produced and sent to you will be helpful to the staff.  When they see a red dot, they know they have already transferred the necessary information to your office.

Patient Transaction Information
How you gather this information will depend upon how your client is capable of providing it.  Ideally, the client can produce, by patient, a simple report detailing all charges broken up by insurance claim submitted (or date of service), all payments posted against the claims (and who the payment came from), and any outstanding patient account balance.   Unfortunately, not every software program can produce a report such as this so you might find yourself piecing together reports in order to produce an accurate account balance for existing patients. 

If the software program you are using allows you to enter a "total due" by either "claims submitted" or "date of service", you will have an easier time calling an insurance company to request the status of a submitted, unpaid claim.  There is no need to attach the actual services provided (CPT4 Codes) to the balances that you enter into your system, unless you find yourself needing to resubmit the claim or submit a secondary claim to a secondary insurance carrier.  There are several reasons why a claim might need to be resubmitted from your system, the most common reason being that the insurance carrier "hasn't received the claim."  This will be determined upon calling the insurance carrier to obtain the claim status.

In addition to entering patient charges, you will be posting payments received against the prior "existing" balances as well as the ones generated from your system (new patients you have entered and billed for beginning on the start date).

Breaking it Down
The method behind a "gradual data conversion" allows for the following:

• To begin the billing shortly after the signing of a contract
• To enter information accurately and completely
• To begin the process of following up on submitted, unpaid claims
• To disburden yourself and your clients staff with the time-consuming task of gathering and entering all information beforehand
• To "work both ends" (new and existing patients) and account balances

Inactive Patients with Account Balances (Revenue Recovery)
If you will be handling account balances for inactive patients and/or "revenue recovery", you can prioritize these balances in such a way that will be most beneficial to yourself and your client.  You may wish to have provided a "sliding scale" method of reimbursement for yourself with regard to existing account balances (recommended) clearly defined in the contract between yourself and your client, based upon the "age" of an account balance.  Why?  Because you want to be paid fairly for your time and older balances usually require more research and work on your behalf to get the account paid.  You must also take into consideration that some carriers will impose a "statute of limitations" based upon the date of service or claim submission date.  Initial communication with the insurance payer on older balances/claims is key in successful collecting.  You certainly do not want to extend hours of leg work compiling old claims for resubmission just to learn that no reimbursement will be forthcoming based upon a statute of limitation, no coverage at the time of service, treatment/diagnosis is non-covered, etc.

Prioritizing Revenue Recovery Account Balances
You will need the staff to send you the same information on the patients with older balances as you will be receiving on "existing patients."  In doing this, you will want to accomplish two things:

• Receive a steady flow of "Revenue Recovery" accounts (perhaps 6-10 per week)
• Prioritize the sending of these accounts in the following manner:

Example

1. Newest Accounts with Highest Balances  (up to 2 years in age, $5000+)
2. Newest Accounts under $5000  (up to 2 years in age, $4999 and less)
3. Older Accounts with Highest Balances  (2+ years in age, $5000+)
4. Older Accounts under $5000  (2+ years in age, $4999 and less)

In order to prioritize these accounts, you will need to run an "Accounts Receivable Aging Report" by patient within your clients system.  Then, create a "request log" to fax over to your client's office each week to include the patients' information they should send you for "revenue recovery."  Once the information has been requested, simply highlight the patient on your report...   and once the information has been received, place the date received next to the patient.

This article represents a process of conversion that has worked for me over many years and can sound intimidating if you have yet to perform a conversion.  Don't let it overwhelm you, it's actually a simple process if adequate reports can be produced from your client's software.  If the client is unable to produce simple and adequate reports, you may need to get creative and/or the staff may be expected to spend more time in the "initial compiling efforts."  Rest assured that the gradual conversion process slows down with time until the task is complete.

Tammy Harlan
Medical Billing Course LLC
www.medicalbillingcourse.com