ClaimTek Medical Billing Success Stories

A diagnosis for perfection

Former RN Debra Medina heals billing ills

By Rick Snider

Let's say you're an expert in your field. You know it forwards, backwards and sideways. However, you see people making money in your field that frankly don't know nearly as much. In fact, they're making very good money without half your expertise.

Would it bother you? Would it make you want to create that business, too? After all, if novices can make a living with little knowledge, wouldn't an expert like yourself do very well?

That's the crossroad Debra Medina faced in April 2002. She worked for 20 years as a registered nurse near Houston, Texas with extensive knowledge in managed care and health administration. She approved payment for health claims that were processed by people who didn't know nearly as much as Debra did.

That bothered Debra. Nursing is about expertise. After all, you don't want someone giving you a shot that isn't sure what he or she is doing. Talk about a pain in the . . . well, you know what we mean.

So Debra formed Prudentia, Inc. in Wharton, Texas that not only handles medical claims, but also analyzes how to better bill for services many doctors perform but don't know how to receive payment. Sounds crazy, but many health care providers leave thousands and thousands of dollars on the table because they don't ask for the right type of payment. Debra thinks that's just wrong.

"I figured it would be pretty easy to switch to the other side and know how things should be processed," she said. "A lot of people don't have the clinical or health related background needed to process billing and that amazed me. We provide a much more comprehensive service. As a result, the bill charges and total revenues have gone up dramatically."

Debra is like many people who are 20 years into their careers -- restless. The mother of two whose oldest is heading to college soon wanted a little more return on her experience that owning a business provides.

"You're at a point in your life where you want to be in control of your own destiny and take the benefits that go with that," she said. "It's a good time to do it because the 401K [company retirement fund] isn't growing anyway."

Debra's clients include an ambulance service as well as a cardiovascular surgeon and two family practices that were culled from her past relationships. However, Debra had to prove herself just like anyone else to gain their business.

"A doctor's preference is keeping it in-house," she said, "but they can't afford to in small practices. They can't afford the level of expertise to do a good job on billing. You need someone who's a senior level manager. As an RN, that expertise is what I have to offer that I couldn't without that background . . . . Doctors don't know a lot about coding. One even said he slept through the seminars where they talked about managing a practice. They focus on clinical care. They don't know how to get paid for both a procedure and a visit. The different can be $40 and that adds up.

"I want to make sure that we do a really good job for the client. It's not my goal to have a whole lot of people. I want to establish relations with the providers to make sure we are managing their claims and making sure that they are billing for the services they provided and being paid appropriately. A lot of time people leave revenue on the table because they don't know the proper billing."

The same can be said for the software, which is why Debra chose ClaimTek Systems, a Portland, Ore. company that is the nation's leader in medical billing software and training. Headed by president Kyle Farhat, ClaimTek's software program provides complete billing capabilities so Debra can fulfill all her client's needs.

"I liked their software over others," Debra said. "The price was right. I was able to talk to other folks who used it and they convinced me it would do what I wanted it to. I worked for two other managed care companies and knew what I needed. I wanted something more than processing claims to clearinghouses, but also generate reports to the client. It's critical to me that we capture the appropriate charges for the services."

After all, expert service is what earns respect and respect is what earns clients.