The building that looks like a New Age cotton gin in east Harlingen may reflect the region’s agricultural past, but inside it embodies the border’s future: healthcare services. Valley Physician Services, occupying the 8,000 square foot space since 2005, lets doctors’ offices outsource the complex billing procedures that stand between their medical services and receiving payment for those services.
In 1980 Anne Flory began handling the billing for her father, Valley Baptist Hospital pathologist Dr. David Flory, under the name Valley Physician Services. In 1997, she bought the business from him and took on small medical practices as clients.
“My clients have all come to me because they have been in trouble with billing,” Flory said. The medical practices continue on with VPS once they realize it’s more efficient and cheaper for them to concentrate on providing medical service and procedures, and to outsource their billing to experts in that field.
“Medical billing is complicated,” Flory acknowledged, and it can be a veritable minefield as well. “Medicare and Medicaid audits and fines can be enormous and devastating to a practice. Medicare guidelines change all the time. We have a whole department that does nothing but research billing codes.”
VPS prepares a bell curve for each of its doctors, comparing their procedure rates to national standards for that specialty.
“Some of our doctors want to know every three to six months, because if you’re out of the curve at the top or bottom, that can trigger an audit.”
Flory’s company works to help the medical practices’ bottom line.
“We monitor payments and make sure the doctors are getting paid what they should be, as in their contracts with PPOs and Medicare and Medicaid. We follow up on claims that were denied or rejected and need to be appealed,” she said.
VPS finds out that some procedures cannot be used on a patient with certain conditions or that there is a limit on the repetitions of a procedure in a month and informs the doctor.
“We spend a lot of time with our doctors explaining the importance of these changes in Medicare and Medicaid. We tell them, ‘you have to play by these rules.’”
For more on this story by Eileen Mattei, pick up a copy of the February edition of Valley Business Report, on news stands now, or visit the “Current & Past Issues” tab on this Web site.