Medical Reimbursement Consultants since 1988, serving tens of thousands of physicians
Our Monthly 8 page newsletter on reimbursement, coding, billing, collections, ERISA, HIPAA, appeals, and more. Just one issue may help you increase your income by thousands of dollars a year when you identify just one code you haven't been billing - but should. Some have subscribed to this newsletter for 20 years or longer. shop.donself.com
Terrific resource. I have been in the healthcare reimbursement business for over 50 yrs and I always learn something new from Don's newsletters. Merry Schiff firstname.lastname@example.org
I am the founder of Medical Billing and Coding Services. I always read Don Self’s newsletters. I love to stay up-to date on his newsletters. It does have very valuable updates from the industry that helps me to raise revenue for my client’s practice. Chhaya Patel, CPC email@example.com
I have his ERISA book & subscribe to his newsletter and his Coding Advisor. Yes you can say I
am a 'member of the Don Self fan club'! In the 25 years I have been coding
and billing he is probably the most valuable single resource I have found - with a little humor added!!! DIANA FRANKLIN, CMRS, CPC, ALPINE, TN DIANAF@TWLAKES.NET
Don’s newsletter each month always has something in it that is new to me and I have been in the industry for 20+ years. I like that he infuses humor into his articles so that a sometimes dry subject can have a little levity. Marla Hunt, CPC, CPCO, CPB, RMM firstname.lastname@example.org
Love your newsletter! All useful tips when running a medical practice or billing service. Rick Cotton, First Source Medical Resources email@example.com
I have been receiving Don's newsletter for 25 years. The newsletter is a bargain for the amount of information he supplies. Don keeps me current on the hot items regarding Medicare Rules and Regs, billing, coding an many other items that are useful to me in my cardiology practice. Lynn Elks BSN RN CPC, Manager, Valley Cardiology, Elgin IL firstname.lastname@example.org
Don's newsletters are full of excellent information and billing "nuggets". After reading my first newsletter, our office followed his advice for Medicare annual wellness visits and doubled the reimbursement we receive from Medicare! Anna Pruitt Office Manager, Winnsboro, TX www.drbart.org
I've been following you for a LONG, LONG time. Loved your ERISA webinar and have signed up for the next one. I have your ERISA book, have signed up for your coding advisor/medical code solutions, and for your monthly newsletter. I'm sure you have helped all of us in the healthcare industry to fight insurance companies and standing up for the physicians as well as patients. I would HIGHLY recommend your services. Maureen Kardys MTK Healthcare Coding Chicago, IL email@example.com
Based upon my experience, Don can help you get that boulder up and over the top with high quality content at a great price in a user friendly format. Jennifer Jones, CMRS DayStar Billing Services, LLC Columbus OH firstname.lastname@example.org
I love getting your newsletter! Jodi Morgan, Billing Manager East Texas Foot Associates email@example.com
Don’s newsletter has been a lifesaver for me from my first day on the job to now....nine years later! He has helped me navigate new initiatives and helped our practice be more profitable.
Sandy Baumgarten, Capstone Family Practice, Houston, TX firstname.lastname@example.org
I look forward to Don Self's monthly newsletters. They have helped my billing service get ahead of the curve as rules and regulations change. It is one place that I can easily keep current.
I enjoy how you make complying with the news so easy to comply with. You have definitely helped my clients increase their revenue. Michael Aronson Aronson Billing Service Indianapolis, IN email@example.com
Don is one of the most knowledgeable healthcare professional in the field. He’s my “go to” guy.
Bonnie J. Flom Billing Buddies Minnetonka, MN Bonnie@billingbuddies.com
I look forward to getting Don’s newsletter Stat every month. There’s a wealth of information covered from the latest changes in the industry in simple easy to understand terms to a refresher of some sort. Stat is one of the tools I utilize to help me do what I do better. It never fails and it’s quite remarkable that every month there is a topic that I have a very strong interest in. It’s either relevant to something currently affecting one of our clients or I simply just need to know more about it. I usually get a chuckle out of something which is an added perk, I highly recommend this newsletter!
Karen Habel CDA- Emeritus, CMBSI, CDBSI President Karebilling Services, Inc. firstname.lastname@example.org
I look forward to the e-news each month. There have been many things I have missed. It helps keep me updated with this fast pace of insurance that is constantly changing. It's been a great help!! Marilyn Marcus D.O., Miami
We have been STAT subscribers for many years. The topics provide helpful insight on every day situations we encounter. Thanks so much, Don & Team for keeping us up to date & in the know! Kimberly Cassell, Admin, - Carolina Family Healthcare email@example.com
We have subscribed to Don Self’s newsletter for 2 years now. We try to keep active on the forum that Don selflessly offers at no charge, however the newsletter covers topics above and beyond those discussions. I have found it a valuable resource to take to providers who do not want to weed through dozens of emails for concise information on issues affecting our practice. Dawn Breithaupt, CPC Preventive Medicine Associates Camillus, NY
Less than 5% of billers, coders, managers, physicians and health care attorneys realize that 80+% of the claims they file every day are ERISA claims.
Why is this important?
The 1974 federal ERISA law applies to every one of those claims and that law gives protections to the patients - and those protections apply to the clinic, the physician and the hospital when the patient has assigned their rights to the medical provider.
Those rights trump anything the doctor may have signed with the carrier. For instance, the doc may THINK that they have a 90 day filing deadline - but if it's an ERISA claim, it might be a year, as it's whatever the patient's POLICY says. The contract the doc signed means nothing as the policy is ALLLLLLL THAT MATTERS.
When you get a refund demand from a carrier - you can stop the carrier from recouping if it's an ERISA claim.
When you get a timely filing denial from the carrier - you can make the carrier pay if it's an ERISA claim.
When you get a denial for a service being investigational or experimental, you might still be able to make the carrier pay, if it's and ERISA claim.
The list goes on and on. See what medical billing professionals have said about the book:
I have used Don’s books, Coding Advisor, slide rule and I am love them all. They are done so expertly yet are so easy to use. Don is a great resource to anyone in the coding field.
Lois A Simmons, RHIT, CCS-P
Coder/Abstractor, OSF Medical Group Surgery
"Don, your advice was right on the money! I received a request for a refund due to policy termination and responded on 06/30/15 with your letter from your book addressed to the CEO. I was delighted to receive a call on 07/07/15 indicating the request had been made in error and to disregard it. How refreshing to have something work the first time and immediately. Please feel free to share this to encourage them to get on the ERISA band wagon. " Mary Bergstrom St. Cloud Ear, Nose & Throat Clinic
"Can't stress enough to you all how effective it is when you send your complaints directly to the CEO/Attorney's of the Insurance Companies. I had sent an appeal to Anthem 3 times without a response and then tried to contact our Provider Rep and couldn't get a response from her either. I typed up a letter to the CEO explaining how this lack of response was "In my opinion' a violation of the ERISA and said if I received no response within 5 days we would look into a potential law suit with punitive damages. Low and behold I got a call from our Rep THE NEXT DAY!" Lori Braidic Billing Manager Womens Care Center of Columbus, Inc.
"How appropriate to end the day with notification from a major insurance company that an appeal previously denied for timely (due to the 90 day payer contract) was successful! Prior attempts the "conventional" ways had failed and without the ERISA knowledge the claim would have been written off. ---Suzanne “ firstname.lastname@example.org
"I have had so MANY problems with my own insurance policy which is ERISA.. and double whammy.. UNION plan.. Friday, I picked up my mail and they paid all claims I had in appeal using ERISA.. THANK YOU DON!!!!! In all my years of working in this business I never realized how much ERISA really mattered until you taught me.. Linda Walker” Practice Managers Resource & Networking Community http://www.billerswebsite.com
I normally don't buy "work" books unless the company pays for them, but after using Don's website and his medical list serve for years now, I felt they would be well worth my money and, boy, they have been. The ERISA books have helped me get claims paid and recoupments reversed. The sample letters have made my job much easier, too! You need all the help you can get in medical billing and I highly recommend all 3 of his books, his newsletter, his free list serve and his coding software.
Cindy Block, Billing Manager
Tri-Care Family Medicine email@example.com
Anytime an insurance company has requested a recoupment or takeback in the past, we would just hand it over...until now. I did my first ERISA appeal to BCBS and within 8 weeks, received a letter that the decision had been overturned!!! We "won"! BAM. Its been a huge plus for our practice. Heather Billing Manager TIMC -Texas
"This is not a subject they teach in school and every medical office needs to have knowledge of this subject." Virginia Hart Craig Austin Family Allergy, Austin, TX
"He provided me with a new path for appeals. Even after 34 years in billing and coding it is always exciting to get those "AH HA" moments that will help increase your revenue. Lynn Meadows Advanced Surgical, Mesa AZ
"If you do not have ERISA tools in your denials toolbox, you are walking around with an empty toolbox and are unable to optimize the compliant income your providers worked for and should be paid for." Barbara Cobuzzi CPC
"Highly recommend! I learned there is help to fight back, great examples to help you take the correct steps, and the right verbiage to make your case!" Melanie Rowls, ENT Specialists of Arizona, Tempe AZ
"If you bill insurance, you need to know about ERISA. Don't just give your money away!" Linda Vargas University Physician Associates, Kansas City
This 318 page MEDICAL OFFICE MANAGEMENT book, updated early 2018, helps the medical office from a politically incorrect approach (saying what needs to be said). Our monthly publication is thought to be a Medicare newsletter, but it goes far beyond just Medicare. All 3 publications deal with medical billing and coding as well as:
Marketing your practice
Column In Local Newspaper:
Local Speaking Engagements:
Medicare Participation Status
Participation With Managed/Mangled Care Plans
Red Flag Laws
Provider Identity Theft
Copying Patient’s Driver License
Copying Military Id Cards Is Legal
Patient Hesitant To Share Social Security Number
Copying Medicare Cards
Prior To The Patient Arriving
When The Patient Arrives
The Reception Area
Why Patients Leave Clinics
Collecting The Deductible And/Or Co-Insurance
Fees & Discounts
Double Booking – Double Trouble
Divorce Poem To Patient
47 Million Uninsured?
Collecting The Co-Pay Prior To Seeing The Doctor
Office And Insurance Theft/Fraud
The Medical Office Manager
HIPAA – Not HIPPA
Breach of PHI
Patient Sign In Forms
Locking File Cabinets
Calling Patients By Name
E&M DOCUMENTATION PRINCIPLES
Medicare Documentation Pointers
E&M Chief Complaint:
History Of Present Illness
Review Of Systems (ROS)
ROS – Non Contributory
Past, Family, Social History (PFSH)
Exam Body Areas
EMR Incentive Payments
EMR – True Benefit
Mediocre Care Not Acceptable
New & Established Patients
Medicare Advanced Beneficiary Notice (ABN)
Using A Nurse Practitioner Or Physician Assistant
Incident-To Is Not For Physicians
Billing Family Members
Members of Patient's Household
Charges for Physician and Physician-Related Services
Charges for Items Furnished by Non-Physician Suppliers
Consultations Are still billable
Medicare Secondary In Hospital
Pre-Op Physicals Are Consultations
Office & Other Outpatient Visit Codes
When Doctor Doesn’t Document Enough
Linking Diagnosis Code To CPT Code
Local Coverage Determinations (LCDs)
Choosing The ICD-9 Code
When Is A Nurse Visit (99211) Appropriate?
99211 & PT/INR
99211 for Anticoagulation Management “Do’s”
99211 for Anticoagulation Management “Don’ts”
Using Time To Determine Level Of Code
Prolonged Service Coding (99354 – 99357)
Initial Inpatient Care (Admits)
Admit From Emergency Room To Inpatient Hospital
Admit To Critical Care From E.R.
Critical Care In Any Place Of Service
Outpatient (24 - 48 Hour) Observation Admits/Visits
Patient Is In Observation For Less Than 8 Hours:
Patient In Observation More than 8 Hours, But Discharged Same Date
Patient In Observation Over More Than One Date
Discharging The Patient From The Hospital
Hospital Discharge & Nursing Home Admit On Same Day
Pronouncing Death – Signing Certificate
Modifier 52 Vs Modifier 53
Progress Note Blunders
Signed, But Not Read
Sports & School Physicals
Health Reform and more
Along with their diploma, this book should be given to all medical school graduates. I only wish we had this type of practical information available when my husband started his practice!
Marvel J Hammer RN CPC CCS-P PCS ACS-PMCHCO MJH Consulting
This information is fantastic. It's exactly what office managers and physician's need to read and hear in these troubling economic and litigious times. Proper reimbursement has become the most difficult task for every physician's practice. Way to go Don!" John Bishop, P.A
This book is the fasttrack to moneytown. You've done what I’ve wanted to write about for years.
I think managers and physicians would be hard-pressed to find this amount of information available in one book. The Unfiltered Guide to Medical Office Management is the "bible" of medical office management! What you have successfully developed is a comprehensive guide to just about all aspects of physician billing, coding, collections and compliance in one easy to read (and entertaining) tome! Just implement a few of these tips and you are on your way to a more efficient practice. Don has provided information on increasing revenue and sharpening efficiency...both extremely important in these tough times. ~ Charlene Endre-Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS, - Administrator, North Scottsdale Family Medicine
"WOW!!! What a book. It took almost a month before I opened your book and then, I could not put it down until the very last page. If I would have had this 20 years ago, I would have had much less dissatisfaction with the billing system and many more hundreds of thousands of dollars in my pocket. It is an enjoyable easy read and the knowledge will give me the confidence to do both a good job for the patient and to be compensated fairly. Every practicing physician needs to read it and institute it. Jerry Block M.D., Tulsa, OK
"There are not enough good words to describe Don and his books. Don is very professional and knowledgeable and provides good sound advice when needed. Thank You Don for sharing your gifts with us. Jim Rehnberg
"Don has a way of cutting straight to the issue at hand and explaining it in plain English. He is a resource I use when I have things that come up that are unusual in billing and practice management and I have never had him give incorrect information or guidance. I highly recommend his services to anyone new to billing or anyone with many years of billing experience." Marla Hunt, CPC, CPCO, CPB, RMM at Superior Medical Billing Solutions - Lake Elsinore, CA
"Don Self is the most experienced and knowledgeable consultant in the insurance healthcare field! Thank you Don for all that you do! God bless you!" Jessica Monge AMD Global
"His publications and newsletters are spot on; and address the trending issues in time to implement change if needed." Christine Wheeland Foothills Family Practice
"This was utterly amazing. You have taught me so much and opened my eyes to many lost charges. " Lola Foberg