Medical Billing Business
I’ve been involved in medical billing as both a medical provider and a billing services provider for over 25 years. The one unchanging fact is that doctors don’t get paid what they’re owed.
Insurance companies and Medicare have not only cut compensation rates, they have systematically developed elaborate and arcane systems that make medical billing so complicated that individual physicians cannot hope to confront the forces arrayed against them.
Simple, off-the-shelf computer systems, or mom-and-pop billing services manned by minimally trained personnel, cannot successfully contend with the constantly changing and sophisticated systems designed to deny payments. Hundreds of insurance groups, with thousands of payment schedules, are beyond the expertise of even the most expensive solutions available. An alarming statistic is that 30% of medical bills are either denied or underpaid.
I used to tell a joke that “there are no PhDs in medical billing.” But Yuval Lirov represents a new paradigm for medical billing, which turns this joke on its head. He’s a PhD in mathematics and computer science, with an unmatched expertise in modern transaction processing, who brought transformational technology to an industry mired in obsolete methods and thinking. Rather than surrender to the overpowering and relentless tactics of the insurance companies, he has designed a solution that matches the power, sophistication, and cost advantages of the insurance companies to finally give the advantage to the physician.
In Medical Billing Networks and Processes, Yuval identifies and analyzes the problems facing physicians, and then he offers his unique and proven solutions. Medical Billing Networks and Processes is the best book I’ve read for understanding and addressing the problems faced by physicians in their quest to be paid in a fair and timely manner.
This book is a service to all of those who wish to understand the billing process—and those who wish to address their own billing issues. This follow-up to his first book, Practicing Profitability, broadens the scope by bringing in more information relevant to a wider range of medical specialties as well as physical therapists. Insurance billing represents the vast majority of income for most physicians and therapists, yet they typically find themselves exerting less and less control over this vital portion of their income. Attempts by physicians and therapists to bill in their offices have become increasingly difficult and costly. Outsourcing billing, in many instances, gives up control as well as the ability to truly judge the quality of the billing services.
Yuval’s solutions address these issues in a manner previously unavailable to the majority of practices. Continued changes make the issues in Medical Billing Networks and Processes timelier than ever.
—Douglas Cassel, MD
Vista Billing, LLC
Newport Beach, California