How and why did you get into this industry?
I actually entered into the physician billing industry, like many people in this business, quite by accident.  I was working full-time as an Administrative Assistant for the Medical Director of a large emergency medicine practice in Ohio and going to college in the evening.   One day, he was at his wits-end with his Billing Manager.  He stormed in with a pronouncement, "Dumford, you are my new billing manager!"  Over time and through acquisition, we finally operated eight free-standing emergency centers.  Through this growth, came the opportunity to be promoted where I ultimately served as Vice President of Operations for Universal Health Corporation out of Cincinnati, Ohio.

How did you become part of HMBA and why did you choose this association over others? 
I moved to Atlanta in 1995, and became Vice President of Business Services for Medpren, a full- service billing company.  It was clear to me that HBMA offered many resources we needed as an organization to stay abreast of current issues in the industry, and was the place for me to go for educational offerings that addressed the day-to-day operations to ensure we ran a very tight shop.  From this one association, I was able to gain significant knowledge on operations, compliance, and be alerted to any government regulatory issues that would be affecting my business.

You have a very impressive educational background. How has this enabled you to grow professionally especially in this industry and would you consider any other study? 
As the saying goes, you are never too old to learn, and I am a firm believer in education, whether it is a formal course of study or a single webinar, or learning by reading a book.  Getting a doctorate degree still crosses my mind from time-to-time, and there are some other areas outside of healthcare that are intriguing to me that I might pursue as I get closer to that retirement age. My personal commitment to continued education has allowed me to appreciate the emphasis that HBMA has on continuing education through webinars, audio-casts and conferences.

In your opinion, what are some of the key areas where physician practices need to spend a little more time or training on to stay profitable?
In a nutshell, physician practices need to keep a keen eye on their business processes.  Often this is difficult to do because the physician wants to do what they are trained to do....practice medicine.  So many dollars are lost just in sloppy office practices, poor reporting, and mismanaged receivables management.  The physician should make certain to get adequate ongoing reports form the office manager and/or the physician's biller to ensure the stable health of the practice.

Why are compliance programs so important and how can an office ensure their staff are using the programs? 
Effective compliance programs are an essential requirement for billing and providers of any size  from the very large to the very small.   Coding is the number one risk factor for all billing companies and a compliance program must address the risks associated with coding.  While a compliance program is often thought of as only a way of making certain you are following the rules and regulations, an effective compliance program can assure your organization is operating in a manner that closes any gaps on missed billings or lost revenue.  It forces you to tighten up all of your procedures and gives you important checks and balances.

As the current Director of Operations & External Affairs for the Healthcare Billing & Management Association (HBMA) can you give us a quick overview of HBMA and what your role entails?
The Healthcare Billing and Management Association (HBMA) is the premier trade association representing both first and third-party billing professionals. HBMA is dedicated to working on behalf of the membership and the entire medical billing industry for the purpose of education, training, professional development, and industry advocacy.  The HBMA membership represents over 700 medical billing companies employing more than 30,000 staff managing claims on behalf of hospital-based physicians, office- based physician practices, and other allied healthcare providers. 

I serve HBMA as Director of Operations and External Affairs.  In this role, I work very closely with the day-to-day operations to ensure the association runs as efficiently as possible and to support the membership and Board of Directors.  I also work very closely with many of our related associations, building relationships with the payor community, and assisting the government affairs office as needed.

Do you have any advice for billers on spending some time right now learning the fundamentals of ICD-10? 
The date has been confirmed for October, 2014, and therefore; all billers, providers and staff need to have a plan in place for readiness.  First, begin with the basics of learning what is different between ICD-9 and ICD-10, and then set a plan in motion to ensure you will be as confidently ready as possible come October, 2014.  HBMA is one organization that provides many resources for assisting organizations prepare for the transition to ICD10.  I think it is important to understand that this will be a huge transition and consideration needs to be given to offering the right kind of orientation training for not only the physician, but also for the support staff and billers.

When considering new staff for any practice, how important is it that they be certified, or what past education do you look for and why?  Certification is important because it does indicate, at a minimum, the individual took the initiative to become certified.  Understanding the core elements of the certification is important for employers because it gives you a basis of knowledge that you should expect from the employee.  Not all certifications are the same, so just because someone carries a few initials after their name does not mean they can walk into a job without further training.  When you see that someone has a history of going to school or taking classes, it tells me they are interested in improving their skillset.  Continuing education is always a sign of someone who is trying to better themselves.  HBMA offers a certification program that is designed to encourage excellence within the HBMA membership through education and awareness in the industry.

What areas do you think billers should be looking to add to their education now and in the near future? 
Certainly understanding ICD-10 should be a priority at this point.  Second, understanding the aspects of some of the changes coming at us; for example, the Accountable Care Organization and how that will impact your practice or your company. And, understanding and embracing all the technology options that are available to streamline work processes are also extremely important..

What words of advice would you give to other professionals and new industry members who aspire to supervisory positions?  
First and foremost, align yourself with a go-to resource to make sure your skills and knowledge keep you at the top of your game.  The business of healthcare billing is changing more rapidly today than ever before.  There are huge considerations facing physicians today.  Electronic Medical Records, Compliance, ICD-10, continued reduction of reimbursement or alternate payment models and technology requirements, are just a few of the considerations facing physicians.  A physician that does not stay on the cutting edge of technology in the business office will certainly lose revenue.  As a professional supporting physician services, you would be wise to understand the changes happening in healthcare, and then make certain you are equipped to assist your physicians in navigating those waters.

For more information about HBMA, please visit http://www.hbma.org