Merry Christmas and Happy Chanukah?

We at URS are wishing everyone the best over this fun filled holiday season of joy and happiness. Well, at least to all those financial institutions which are under the pressing thumb of the `Powers That Be’. The banking industry is becoming increasingly difficult to expand its customer base and grow bottom lines.
Consider the following recent and pending stranglehold tactics:
- Disclosures, notices, statements, forms and tax documents — about 300 pages and just for home loans. Bank processed 455 home loan applications and they created more than two months of `make work’ and the estimated labor costs reached $12,000.
- One bank vice president says the Dodd-Frank Wall Street Reform and Consumer Protection Act, which became law in July 2010, nearly doubled the review and reporting process to regulators, with little margin for error. And that is only a portion of the avalanche of new regulation that has executives at smaller banks concerned.
- The bill is massive — 2,300 pages — and bankers expect it to result in 5,000 pages of new rules as regulators turn its mandates into specific instructions for financial institutions in coming years.

Bankers are very concerned about the abundance of new legislation because it will choke neighborhood banks’ bottom line and virtually place them as prime targets for takeovers by larger, national banks. This legislation appears to have been cultivated by some devious and purposeful late night `strategy meetings’ by certain Congress people and bankers. But then again, this is purely speculation.

Small banks in America have been disappearing for decades. For example, in 1984, the largest banks in America — those with more than $10 billion in assets — controlled 28% of the industry, according to FDIC data. Now, these larger banks control 79% of the market. Banks with less than a billion in assets are holding 11% of the market, compared with 40% in 1984. Bankers believe Dodd-Frank will hasten the consolidation.

Bankers are very concerned about the abundance of new legislation because it will choke neighborhood banks’ bottom line and virtually place them as prime targets for takeovers by larger, national banks. This legislation appears to have been cultivated by some devious and purposeful late night `strategy meetings’ over the past decades by certain Congress people and bankers. But then again, this is purely speculation. Since the 1800’s, neighborhood banks have been instrumental in cultivating small geographical population areas and today this wholesome and warm relationship is slowly disappearing.

What Social Media Provides Physicians

Social Media is becoming the common, easily accessible vehicle by which many people, including physicians, are communicating. This form of communication or social interaction is very convenient for all to use; Twitter and Facebook are probably the most common media used and are very simple. Just as celebrities tweet “getting my nails done” and college students tweet about an upcoming party tonight, a physician can tweet about a stomach flu that’s going around in their community.

"If you go back two generations, doctors came to your house. They lived in your community. They probably went to the same church…With social media, "what we're really doing is going back and creating a more personal experience with technology." - Jeff Livingston

People like to feel a part of a community and the more you involve yourself personally, the more you are viewed as approachable, a reliable resource and respectable. Everyday physicians are creating Twitter and Facebook Pages as a way to:
·         Connect among other physicians
·         A resource for patients to turn to
·         A way to view what patients are thinking- since communication is rare between physicians and patients
·         An avenue to voice your opinion- as it can go unnoticed with so much use of WebMD and Google
·         A bigger draw to your practice- if a patient follows you & forwards an informative tweet to a friend, expect    more patients

Even the AMA has placed a social media policy which contains guidelines of implementing privacy settings on sites such as Facebook & Twitter. Also, it encourages maintaining appropriate boundaries of physician-patient relationships on the web. However some physicians aren’t respecting these guidelines according to Kevin Pho, a primary doctor based in New Hampshire, “The problem is that some [physicians on Twitter] break Pho's cardinal rule: Never use Twitter to dispense medical advice or comment on a patient.” source

The guidelines to setting the privacy on social accounts weren’t as thorough as expected from AMA, however. If you are concerned about your privacy, here are step-by-step guides for Twitter and Facebook.


More Government Intrusion...Why?

Illinois Democrat, Dick Durbin, has pushed legislation which went into effect a week ago. This legislation limits the fees big banks collect from merchants and he now finds himself the fall guy for Bank of America’s new $5 monthly debit care fee. His response was a ranting and raving and even suggested that consumers “get the heck out of that bank”. Holy cow, you’ve got to be kidding me! Since when does a politician publicly denounce a specific business entity then recommends do not buy or use its services?

Many Americans have always been under the impression that they have the capabilities of deciding which goods and services better suit them, including prices. Over the past several years I have noticed that the intelligence level of Americans has precipitously declined and, fortunately, some Senators and House members are there to rescue us from any and all financial disasters.

I firmly believe that when unfettered competition is allowed to determine the value of products and services offered, businesses and individuals are fully capable of taking decisions as to which products or services serve them best based upon specific cost-benefit evaluations. However, over the past several decades, politicians have been forcing their influence into both consumer and business buying habits of certain products and services. It appears this trend has taken effect because many politicians are easily convinced through glib lobbying persuasion tactics. For example, company A has been investing millions into its new business service software products and, unfortunately, several competitors have quickly developed products which have cut into company A market and, in some cases, have received positive news. In order for company A to regain its market share dominance, it solicits the services of a renowned lobbyist who successfully influences politicians to place expensive legal restrictions, special software licenses and federal and state licensing restrictions to legally market similar services. Smaller and new entrants might find these new restrictions to be cost prohibitive and leave the competition thus freeing up company A to greater success.

Similar tactics have proven successful in the banking industry when large national and regional banks place additional financial burdens on local and smaller successful banks. This would include enforcing greater scrutiny on mortgage loans, including larger down payments and imposing larger reserve funds. The latter reduces available funds loans and constrains cash flow. So sooner or later these smaller banks become increasingly frustrated and sell to a larger financial institution. One way smaller banks can extend life is to evaluate and utilize the talent of outside sources. This serves several critical financial benefits such as savings on hiring and training personnel in the collection or credit granting departments. Banks can observe, manage, evaluate, change, observe and manage operations at the drop of a pen.


Results are Changing Quality of Care by Richard L. Tamburello

Medical practices need to re-design office operations because costs are rising and reimbursements are on a downward trend. In fact, reimbursements are expected to decline over the next several years. What is adding more pressure to the practice’s survival is the patient! Patients are becoming more demanding about the care which they receive, including expecting to be seen by the doctor at the scheduled appointment time. Patients are also becoming more impatient because of added bureaucracy such as being asked to see insurance cards, completing various demographic forms and being asked a barrage of questions on each visit.

Patients now have access to a variety of resources where they can see opinions of healthcare providers written by other patients who have received care by the prospective practice.  Additionally, patients are paying higher premiums along with deductibles. Patients are becoming `healthcare’ shoppers looking for quality care at bargain prices. The quality of care is changing…maybe to better serve patients.
Practices are in turn becoming increasingly competitive such as asking patients more questions, spending more time during each visit and improving `bedside’ manner. Many medical practices are seeking alternative ways to reducing and better controlling both administrative and operations costs, as these factors can negatively impact cash flow. Practices must also take into account that addition and increasing costs are coming down the pike.

More and more healthcare providers are exploring alternative cost-effective methods for managing several key aspects of typical front desk and `backdoor’ staff activities. For example, the specialist’s staff focuses on obtaining authorizations, determining eligibility and validating or obtaining referrals.  However, all practices in addition to entering and scrubbing charges are filing claims, posting payments, conducting insurance follow-up campaigns, sending statements, responding to patient inquiries, filing appeals, greeting patients and making appointments. Many medical practices have discovered there are several key and viable solutions which do offer significant expense and cost reduction controls. One is securing the services of a trusted and proven medical billing service.

Medical billing services can perform the day-to-day billing tasks with greater efficiency because of fewer non-billing interruptions. Some billing services will also conduct eligibility, authorization and insurance contract services. Fees charged by billing services are usually based upon generated revenues, meaning there is an incentive to perform. Those medical practices using a trusted and proven billing service will, in most cases, begin to see the positive results in the bottom-line, thus giving doctors more time to provide quality care and see more patients. Times are changing and now is the time for medical practices to focus on and provide patients with quality care!       

Insurance Lobbying by Richard L. Tamburello

The number of companies and various organizations that work to put their imprint on legislation is diverse, ranging from health care interests and advocacy groups to giant corporations and small businesses of all types including many insurance companies.

Among the lobbying groups, there are over 200 hospitals and 100 insurance companies which line the halls of Congress to be heard and generate influence. One of the most visible organizations to lobby Congress is AARP.  It has anywhere between 56-60 in-house lobbyists and two from outside firms to work the issue on behalf of its members. The American Medical Association has 33 and 11 professional lobbyists from outside firms.

Influence peddling is big business and Congress loves the attention and the selective influence it generates. Think about it, advocacy groups invest over $3.50 billion for lobbyists to represent them on all kinds of issues, according to the nonprofit group Center for Responsive Politics. And I thought `we the people’ who voted for our elected officials had influence – Yea Right! So what actually happens is that once the votes are counted, our elected officials immediately align themselves with various advocacy groups, lawyers, special interest groups, lobbyists and we, the constituents, are to a large extent, forgotten until the next election.

Insurance lobbyists represent the financial interests of the insurance company industry and the members of Congress supposedly represent their respective constituents. Today, many Americans have become disillusioned with elected officials because politicians are more interested in power, influence and themselves.

The exact amount spent on health reform is difficult to quantify because most health care lobbyists work on other issues and lobby disclosure rules do not require businesses to report how much is paid on each issue.

In conclusion, the AMA succeeded in molding House and Senate bills to make sure cuts would not come out of doctors’ pockets, Wilson said. The AMA helped kill a $300 yearly fee for doctors who participate in Medicare or Medicaid, a tax on cosmetic surgery, 5% Medicare payment cuts to the top 10 percent of Medicare billers and Medicare payment cuts for primary care physicians. Now we hear that many physicians are opposed to the AMA because of recent speculation that the government now wants all physicians to provide it with the once thought `private patient’ data. When will it stop?


Outsourcing: Should We?

Credit decisions greatly impact and influence revenues, bad debts and bottom lines. In today’s weak economy many or should I say most bank credit departments have tightened the rains on extending credit. Today, this practice is evidenced in fewer mortgages, personal and business loans applications and approvals.

As a result, many banks and related financial institutions are reducing employee levels by offering early retirements and imposing terminations. It is likely that the current economic conditions will continue for several more years. The housing market is still sluggish and it is having a domino effect on all those businesses which comprise the housing industry: masons, carpenters, roofers, window manufacturers, landscapers and many other related small businesses.

These unfortunate, poor economic times are causing many businesses to rethink how better to control and manage billing and collecting departments. Although there are `ebbs and tides’ in our economy, businesses are re-thinking and re-evaluating the cost-effective attraction of outsourcing some and all these related departments to professionals. There are several clear advantages outsourcing offers; one of which is that the client only pays for results. For example, ABC Bank employs a staff of 20 in the collections department and it costs about $500,000 – $600,000 in salaries and benefits. These fixed expenses remain constant regardless of the level of generated collection revenues.

The company which outsources its collections department only pays for results. That is to say, using the same example, ABC Bank contracts a professional outsource company to conduct the same responsibilities produces about the same level of revenues, yet it would cost the bank about half the amount, but all of the headaches.

There are additional benefits that can result from outsourcing: fewer personnel to supervise, better manage reduce payroll and related expenses, develop new products and services, promotion of personnel to more challenging positions and, more importantly, grow the business.

Finally, businesses and banks are and will be accumulating data and taking decisions on the financial benefits of outsourcing certain or all aspects of collections and credit granting processes. The ideal outsource candidate has in-depth personal and business loan credit and collection experience, performs credit approvals utilizing secure web-based credit bureaus and criminal background checks resources. It’s becoming quite clear that businesses which are on the cutting edge of growth and market penetration will dominate tomorrow’s businesses.


Effectively Preventing Unresolved Charges

Working unresolved charges can be very unnerving and, of course, time consuming and labor intensive. Many medical offices are having to deal with numerous unpaid and denied charges because of a variety of reasons such as: cannot identify patient, procedure and diagnosis codes don’t match, patient not eligible on date of service, no authorization for charges and no referral on file. Sound familiar?
Many of these denials can be minimized or avoided only when medical practices institute and follow specific office policies. Let’s examine the policy most practices follow when a patient makes and appointment. The policy should include asking the patient’s name, date of birth, current medical insurance company and amount of co-pay? When the patient arrives for her appointment, front desk personnel should scan member’s card and call for eligibility. Adhering to this policy should help reduce additional administrative time needed to conduct insurance follow-up.
In cases of surgeries, or other procedures which require special medical treatments, it is absolutely essential front desk personal obtain patients complete medical histories, authorizations and, in some cases, letters of medical necessity. Medical personnel need also to make sure that when obtaining authorizations to accurately indicate to insurance companies all diagnosis codes in correct descending order of seriousness and procedure codes. It is also advisable to record name and contact information of the person who either approves or denies authorizations. Strong adherence to this policy should also help minimize insurance charge denials.
Finally, the URS staff has one sure method of controlling and minimizing future costly insurance follow-up campaigns. The staff resolves most of its denied charges when posting payments and calling insurance companies to ascertain reasons for denials and nonpayment’s, then submitting all necessary corrective measures to insurance companies. Those few claims which cannot be resolved during this process are set aside for appropriate handling.  


Deciding the Future of Your Practice, Managing Director, Richard L. Tamburello

Let’s assume the following negative financial consequences: increased taxes, more regulations and reporting requirements, rising indirect and direct employment costs and declining reimbursements. 
Introducing: CMS issues proposed rules impacting reimbursements:
Should one or a combination of any of these financial burdens directly affect your medical practice, it could experience significant declines in cash flow and profitability. These concerns are present in the minds of both physicians and administrators. Many practices, regardless of size, are not sure which course of action to take or how to overcome and deal with these expected additional rising costs and cash outlays. Some practices might close within the next year or two and some physicians might decide to retire early.
What viable alternatives and solutions should medical practices take? The first step is to objectively assess the efficiency of the office. Do any employee’s responsibilities overlap? Are employees maximizing their talents? Is absenteeism a problem?  Are insurance follow-up, payment postings, charge entries and scrubbing accurately and timely conducted? Should your practice display any of these key operation weak points, revenues, profits and cash flow will negatively impact the bottom line.
Lastly, the ideal way to reduce costs and increase revenues is to utilize the medical billing professionals. “The American Medical Association (AMA) reports that an average of $30,000 from a $300,000 practice is spent annually on in-house billing. This amount can effectively be cut in half, when contracting the expertise of a proven billing service. “ source
There are several professional medical billing services which provide cost effective results-driven A/R management solutions. Outsourcing billing operations can be a viable alternative to medical practices seeking increased revenues, timely charge scrubbing, payment posting and effective insurance follow-up.  A highly functional medical billing service will accomplish these objectives and more. One additional key financial component URS Billing Services, LLC delivers to clients is `Increasing the Value of The Practice’.


Bad Debt Syndrome by Richard L. Tamburello, Managing Director

Given the unfortunate economic circumstances for millions of Americans, more and more medical practices are finding it increasingly difficult collecting deductibles and self-pay balances.  This situation is not only impacting cash flow for practices, but negatively affecting bottom lines.  According to a recent study published in the American Journal of Medicine, 2007, “Medical bills are the cause of more than 60% of all bankruptcy filings in the United States…” Many patients ask, “Why aren’t insurance plans covering more of the medical expenses”? As a result, medical practices are now dealing with the uncomfortable task of asking patients for payments after treatments and before they can be seen on the following appointments.
URS recommends the following to minimizing bad debt losses and maximizing cash flow:
  1. Inform patients of payment policies prior to being treated. Office policies should include a list of accepted credit cards and a credit agreement which is to be signed by patients/guarantors who do not have insurance or high deductibles (HSA).
  2. Select patients for collections using these criteria: Minimum of 3 statements and no contact from patients indicating willingness to arrange payment plans; balances > $49.99; mail is returned.
  3. Contact with patients should be geared to `motivating’ patients to pay, not via intimidation tactics.
  4. Patients with insurances should have their policies (including secondary insurance) validated prior to the office visit date.
  5. Surgical practices need to call insurances for eligibility, authorizations based upon Diagnosis codes presented in ascending order.  This should be completed a minimum of 48 hours prior to the scheduled surgery date.
Keep in mind these are some basic procedures by which medical practices can minimize the Bad Debt Syndrome in today’s economy and in the future.

Efficiency = Increases Cash Flow, Bottom Line & Practice Value

Many medical practices find difficulty identifying inefficiencies or implementing corrective actions identified as inefficiencies. Many medical practices fail to establish `Key Financial Indicators’ (KFI’s) or operations benchmarks for such areas as: Average Revenues/Patient Visit, Revenues to Total Procedures, Fluctuations in Procedure Code Levels, Average Days Revenues (ADR), Days Revenue Outstanding (DRO), Days in A/R and Delinquency Tolerance Ratios (DTRs) and tracking amounts allowed and reimbursement levels by ALL contracted insurance payers.

These critical financial measurements are absent in many practices having 7 and fewer physicians. URS Billing Services provides these and much more key data to all of its clients.  The success of today’s medical practice requires pinpointing weaknesses and taking necessary corrective actions. Measure! Evaluate! Take Action!

Key Operation Benchmarks Which Are Monthly Tracked Per Physician:
-    Charges
-    Revenues
-    Adjustments
-    Net Ending A/R including net change from previous month
-    Percent Revenues to Gross Charges
-    Total Patient Visits
-    Average Revenues Per Visit
-    Establish / Measure Delinquency Tolerance Ratios for A/R
-    Establish / Measure Revenue Sources to Total Revenues
-    Establish / Measure ADR Targets
-    Establish / Measure NDRO Targets
-    Establish / Measure Days in A/R
-    Establish / Measure Revenues For Top 15 CPT Codes
-    Establish Solid Relationships With ALL contracted Insurance Providers

Once these Key Operations benchmarks are established, correctly monitored and managed, along with `alert algorithms’, profits and cash flow will begin to rise. Physicians will be able to draw paychecks the same day as employees.
The URS management team’s principle fiduciary responsibilities to ALL of its customers are not only optimizing revenues and controlling costs but increasing the value of the client’s practice.

The URS management team’s principle fiduciary responsibilities to its customers are not only optimizing revenues but increasing the value of our client’s practice.


How to Increase the Value of Your Practice, by Managing Director, Richard L. Tamburello

Increase the Value of Your Practice
In today’s economy many physicians are fearful of seeing the value of their practices evaporate. Two primary reasons are stagnate and declining insurance reimbursements.  Other reasons include uncertainty with respect to federal tax policies, mandatory insurance coverage, higher employee payroll taxes, etc.  These can all have a direct effect on valuing your medical practice.
If you were to draw two lines on a graph, one showing gross revenues the other employee costs, the two will likely show trends of moving closer or worse, intersecting, hence impacting cash flow, your bottom-line and the value of your practice.  In past years, the area between the two was likely much greater.
Medical practices should consider and evaluate the financial benefits of contracting with a proven medical billing service organization.  This is the best way to effectively manage and control most billing and collection related costs.  URS Billing Services, LLC has the proven method of ensuring the area between revenues and billing costs never intersect, resulting in improvement in cash flow and profitability. URS takes great pride in servicing its clients medical billing needs and making sure financial goals are met each for each reporting period.


The Importance of Conducting Insurance Follow-Up by Richard L. Tamburello

Insurance follow-up is a billing function for ensuring optimal revenues, minimizing bad debts, reducing patient complaints and accelerating revenue cycles. Over the past 15 years, I have conducted numerous A/R analyses for various-sized medical practices and have found this key aspect is often overlooked. In some cases unpaid claims are re-filed without determining and correcting the cause of denial resulting in an endless cycle of rejections. When the watchful eye of the doctor or administrator is omitted from this vital task, valid charges are written off.    

How does a physician or practice manager know when denied claims are promptly addressed, corrected and re-filed?

I recommend the following method: 
  •    Run a 'Total A/R Aging Report' using the parameter 'Date of Service'
  •    Do not run reports showing 'Insurance Re-billing or Billing Dates'
  •    Generate a 'Patient Balances A/R Report' using the same parameter 'Date of Service' 
  •    Subtract Patient Balances A/R data from the 'Total A/R Report' and it will provide accurate data on unpaid insurance charges
These reports should be run twice a month and provide information as to which insurance companies and patient charges are not meeting timely adjudication.

Tell Us: How often do you conduct insurance follow-up? Is it on your top priority list? 

Questions? Contact Richard @ 


Who Moved My Cheese? by Lauryn E. Tamburello

In college, one of my professors instructed our class to read the motivational piece, “Who Moved My Cheese” by Spencer Johnson. Its purpose was to invigorate the class into thinking about the concept of 'change'. The book’s theme focused on learning and understanding the benefits of being proactive, accepting change, getting excited about change and more importantly, not accepting change could seriously jeopardize the future success of any business.
The reason for me highlighting this book is to urge those who are hesitant, reluctant to change and fearful of losing control through outsourcing should keep in mind `change’ is necessary to preparing and experiencing ongoing success. Here are a few reasons why many medical practices hesitate to outsource certain aspects of their businesses:
-          Is the work getting done?
-          Is the billing company’s staff really concerned about my revenues?
-          Is the billing company looking out for my reimbursements?
YES! YES! and YES!
URS Billing Services, LLC is the fiduciary agent for its customers. It is incumbent upon us to complete all of our assigned billing responsibilities, including filing charges within 24 hours of receipt and matching procedure code reimbursements according to existing insurance contracts.
Financial Benefits

URS' financial benefits can be summed up in two words: Cost Efficient
Now is the time to evaluate for yourself and ask, “are there real obvious and clear benefits to seeing more patients and leaving the billing to URS Billing Services”? Call today and receive a free, no obligation analysis of your practice.


URS Billing Services, LLC Wordle

Wordle: URS Billing Services, LLC Wordle


Credentials of Managing Director, Richard L. Tamburello

Richard L. Tamburello
Managing Director

Richard has over 35 years of extensive account receivables management experience in healthcare, banking and finance.  His expertise is in the formulation and implementation of policies, procedures and strategies for increasing cash flow and improving the client’s overall profitability through revenue optimization, automation and training.  Richard gained much of his management and financial skills at major banking and other financial institutions, and as owner/manager of medical billing and collection management companies.  Richard has also conducted seminars and workshops focusing on effective communication techniques for securing payments from insurance providers, patients and other third party payers.  He has also consulted and developed policies on protecting account receivables.

Richard founded United Recovery Service, Inc. in 1993, after serving as President/Managing Director of Universal Healthcare Management Group, a professional services organization providing reimbursement management services, medical billing, consulting and temporary and permanent staffing solutions to healthcare providers.  Before founding UHCMG, Richard organized a debt collection company in 1982 where he served as CEO for eight years.  The company was responsible for collections of more than 10 hospitals, numerous doctors and physicians group practices and over 70 businesses.  Richard’s responsibilities included managing 45 employees, operations, formulating strategic planning initiatives and implementing marketing policies.

Richard’s specific accomplishments include directing large-scale insurance follow-up reimbursement projects at Sinai Faculty Practice, Johns Hopkins School of Medicine, Southeast Emergency Physicians, Harbor Hospital, Memorial Hospital, Potomac Emergency Physicians and many other healthcare providers.  He also developed and implemented debt collection management strategies for over 150 diversified commercial and retail clients.  Richard held the position of Cost Center Manager at Maryland National Bank where he was directly responsible for over 380,000 credit cardholders and a staff of 25 supervisors and collection personnel.

Richard received his BS/BA degree from American University in 1976.  He has assisted with coaching of JV/Varsity Lacrosse teams at Fauquier High School.  He also has been very active in Fauquier County youth sports were he served as head coach for six years and Treasurer for two years.  He is also an active member of various senior financial executives associations.