Stephen is one of the leading pioneers of the medical billing industry and the founder of Medical Healthcare Solutions. In his current role as President and CEO of MHS, he holds the responsibility for the total medical billing operation, business aspects of the organization and consulting with clients on medical administration and reimbursement procedures.

With medical revenue cycle management continuing to become an integral part of the healthcare industry, Stephen talks to me about how he got started in this industry and his ability to adapt to and overcome the challenges he has witnessed over the past few decades.

Getting started in the Revenue Cycle Management domain

Stephen started out as a pre-med student but made the shift to the business side of the industry. Instead of continuing to med school, he got into the business aspect of physician billing.

He worked in a family business in the healthcare division.  He was responsible for processing dental and pharmacy claims. He later worked with a competitor for a year before developing his business.

He started Medical Healthcare Solutions along with his wife which paved the way for the development of a software they were working on in 1991. Later in December 1995, Stephen and his wife took their business to another platform and have been working independently in the industry ever since.

Recalling his first account, Stephen remembers that it was a referral from a friend of a friend. Their company growth has primarily been via referrals from clients, about 50%, and about 20 to 30% of clients continue their billing partnership with Stephen’s firm even after they leave an organization. Some of the company’s growth has also been through RFPs.

Current business scenario

The company is currently leading a team of about 150 employees. The teams help a diverse set of clients ranging from major teaching hospitals to academic hospitals. The company also works with large provider groups, multispecialty groups, colleges, universities and independent doctor practices.

Additionally, they also specialize in surgery, general surgery, ENT, urology, gastroenterology, mental health, primary care, oncology, cardiovascular, thoracic, pain management and PTOT (Physical Therapy and Occupational Therapy).

Formative moments in the medical billing journey

Recalling the time since he first started out, Stephen has witnessed several changes in the industry and the processes involved. Going from a DOS system to the Windows platform was a big move along with the ease of staying connected via the internet which has transformed the nature of reporting.

However, his biggest moments of pride in his business journey are his long-term employees and clients. With the practices followed by his company, most of his employees and dedicated clients have an average of 20 years with the company.

Overcoming challenges in medical billing

‘Getting the claims paid correctly is getting difficult. We’ve got it down but the insurance companies keep changing their rules.’

The biggest challenge according to Stephen is the payers paying claims correctly. Additionally, having doctors provide the accurate and timely information needed to get claims paid can also be a recurring challenge along with timely payments for the company’s services. Having a skilled team can also be a huge challenge for companies in this industry.

When it comes to overcoming these challenges in medical billing, Stephen credits the software they created in helping them monitor the claims being paid correctly. In addition, they have allowed clients to pay via a longer route that helps the company receive the payments within their guidelines.

Finally, combating the concerns of the labour pool, Stephen’s company has been hiring and training people to replace the employees that will be retiring in the years to come. They are also working with some community colleges that have certificate programs for a 6-9 week internship which could pave the way to a job offer. Additionally, insurance companies that are downsizing also offer trained people that can be hired.

Future business plans

‘We do some advertising, but very little, ours is a relationship business.’ 

When it comes to strategies for growing a business, Stephen believes that the best thing for a company is doing a good job with the clients that you have to encourage referrals. In addition, the company is active on social media including LinkedIn where the post informative blogs.

Marketing and advertising is a minimum as Stephen believes in organic growth as this industry is largely built on relationships.

Staying abreast with changing industrial trends

As one of the pioneers in the medical billing industry, it is important to stay abreast of constant changes in this dynamic sector. To be informed of the latest developments, Stephen attends many seminars. He is also a part of the HBMA and reads a lot. Additionally, he also relies on some of the in-house coders through roundtable discussions.

Top philosophies and core values in business

Revenue cycle management is about trust and building relationships. For Stephen being hardworking and truthful are crucial components for success in this industry. Additionally, it is important to pay attention and listen to what the industry is saying, both from the customers as well as from the insurance companies.

Advice for individuals entering the revenue cycle management industry

Clarity on the job is important here – what position is one looking to do. Additionally, Stephen suggests that one starts as a biller in this industry and learn billing. From soup to nuts, charges, payments, AR revenue, following up on claims and even becoming a certified coder if possible. This helps cover the entire revenue cycle management.

Two learnings in the industry

1. Work for a billing company and receive your training.
2. Become a certified coder

Key benefits of services provided to customers

One of the reasons Stephen’s clients stay with the business for over 2 decades is that they get things paid and save them money.  The company helps increase the client’s cash flow by a minimum of 40-50% and reduce their overhead by 40-60%. That is an incredible value provided at this time.

Business in the COVID-19 era

We were able to continue to work and space out people. Those who wanted to work in the office wore masks and maintained distance while the rest were set-up remotely.

COVID-19 was a game-changer for many industries and this was no different. For Stephen, the biggest benefit of being able to continue to work through the most difficult times was by setting everyone up to work remotely. Additionally, as surgeries got hit and were not being performed as regularly there was a decline but not much as majority of the business was not dependent on the elective surgeries.

Vision for the future of revenue cycle management

‘I really do believe that the service industry for revenue cycle services are going to be greatly needed even more.’

According to Stephen, it is going to become more complicated to get claims paid and physician groups are going to need specialists in order to get claims paid.  It’s going to be difficult for private practices or any practice to take on the role of billing just because of the cost, the overhead, and the skill level involved.

Additionally, complications are likely to occur based on the mindset of physicians in the industry. While some enjoy the autonomy and prefer working independently, there are others who prefer a fixed salary and a hospital structure. With new independent practices coming up, Stephen believes a lot of doctors may prefer partnering with one another in a practice.

Upcoming trends and tips for success in revenue cycle management

For Stephen, a core component is skilled personnel. It is important for a firm to have skilled and knowledgeable people as well as an ongoing training program. Further, it is important to have the resources to back you for the days when the charges are down, because the bills will still be coming in.

Also it is important for people in this business to remind themselves that this is a volume-based business and the margins are thin. So, it may be difficult to make a lot of money on each doctor or each group but a bigger volume can help boost revenue.

When it comes to specialities that are lucrative for medical billing, Stephen believes that surgeries are the way to go. A lot of areas have been hit, including anesthesiology and interventional radiology, but specialities can offer higher revenue. It’s important with everything being globalized to look at everything with a shrewd eye and figure out how much is it going to cost and what is it going to take to get these claims paid.

The medical billing domain is dynamic and is constantly evolving. Staying ahead in terms of technology and branching out into avenues such as surgeries could be lucrative in the future. Ultimately, though, for an organization to succeed, it is crucial to remember that employees are their strongest resource.

 ‘Your organization is only as good as your people. Take care of them, do everything you can, respect them, work with them.  Everyone has a life, everyone has issues, just keep them motivated, encourage them, make it a nice environment that they want to come to work.’

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