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y amy m. armstrong Intensive Specializing for a Productive Business Venture A.J. Riviezzo is in a real tight niche. A die-hard believer in specialization as being the ticket to success in the business world, his motto is, “Do one thing and do it beyond well. Identify your one target and aim anything and everything you pull out of your quiver at that target only and consistently.” That is his philosophy and that is his business plan. It's working for him, too. And more importantly, it is working for his clients. In 2007, Riviezzo partnered with Dr. James Albert, a thoracic surgeon – retired from cracking chests, but very active in the treatment of varicose veins – to form American Physician Financial Solutions, located in Colorado Springs and serving the billing and consulting needs of varicose vein treatment clinics all across the United States. As a niche market, it has highly specific coding requirements for insurance processing, requiring the firm to remain proactive and up-to-date on its constantly changing, incredibly specific billing protocol. Riviezzo didn't necessarily choose this career path until just eight years ago. His earlier working years were spent on the medical side of the U.S. Army. “The military told me I was going to work in health care and so I said, ‘okay’ – because you don’t get to say ‘no’ when the Air Force says that to you,” he told The Suit with a knowing chuckle. After the military, Riviezzo earned both bachelor’s and master’s degrees while working in accounts receivable for a national pharmacy company. Then, going to work for Kaiser Permanente taught him a great deal about insurance coding and billing, but also left him frustrated with the corporate atmosphere. About eight years ago, Riviezzo was pondering whether he had what it takes to create his own billing firm, when he was seized by a sudden inspiration. This is how it happened. He and his wife were attending yet another dinner that her employer – that same Dr. Albert – also attended. Riviezzo had heard the doctor complaining about his billing service at previous dinners and finally decided to employ a little “carpe diem” by asking Dr. Albert how much he was paying currently. The doctor readily supplied the number and Riviezzo responded how – with the amount he was already pay- THE SUIT MAGAZINE - NOV 2014
ing, plus some extra seed money – the two of them could start their own billing service. Riviezzo had a hunch that other doctors specializing in the treatment of varicose veins were experiencing similar frustrations. He was correct. Phlebology – the medical term for varicose vein treatment – suffers the same fate as chiropractic, massage and acupuncture therapies do regarding the cooperation of insurance companies over payment. Insurance companies often balk at presented claims by stating that the treatment isn’t medically necessary. That’s where Riviezzo and his team come in. “You do have to be really specialized about working with insurance companies regarding phlebology,” he explains. “Oftentimes, it is considered borderline cosmetic. So, in getting health insurance to pay for treatment that is in most cases medically appropriate, you have to be pretty knowledgeable about the treatment methodologies and services the physicians are providing to the patients.” As he began working with Dr. Albert, Riviezzo immersed himself in the practice and jargon of phlebology. Today when talking with prospective clients who are phlebology physicians, he often hears comments like, “Oh, I didn't realize that you're also a physician.” He chuckles, telling the prospective client, “No, no – if we talk about anything else besides varicose veins, you will quickly see my ignorance.” Yet, ask him to speak on any subject related to varicose veins, treatment and the justification necessary to secure payment from private insurance, Medicare or Medicaid, and instantly the billing specialist transforms into an expert prepared for discussion. Thanks to changes made by the Patient Protection and Affordable Care Act (ACA) – along with revisions to Medicare, Riviezzo has to really be on his toes when processing claims on behalf of his clients. That is, if he wants the doctors he represents to get paid. Oftentimes, his work involves ed- ucating patients regarding meeting what can be high deductibles under Obamacare prior to receiving services. As Riviezzo points out, the silver or bronze plans offered via the Obamacare health care exchanges include deductibles requirements ranging anywhere from $5,000 to $10,000 per year. These high deductibles force representatives from doctors' offices to financially pre-screen patients. “A fair number of patients are pretty surprised at how high their deductibles are,” he said. “Obamacare is advertised as comprehensive health insurance, but in reality what it is, is major medical.” On the Medicare side, a federal move toward greater scrutiny is prompting significantly more audits. Many do not release payment until after an audit is completed, leaving physicians holding the financial bag. “These audits are aimed at finding fault, not just at verifying factual information – and apparently they are ongoing until they get bored of it,” Riviezzo said. “Thus, the doctors never know when they are getting paid.” With so much compliance pressure, Riviezzo said that it is nearly impossible for workers in a doctor’s office – such as a secretary cross-trained to assist with billing – to keep pace with the demand and expectations, which is a big part of what keeps him in his niche billing and consulting business. “I have seen billing companies that try to be all things to all doctors,” Riviezzo said. “And they make money, but they gain and lose clients at a fast and furious pace because they are not able to bring sufficiently robust expertise to the table. You cannot do orthopedic billing one week, and then suddenly be shuffled off to do ObGyn billing the next. Our goal has been to be very targeted and to be very good at what we do. I would much rather have a steady set of clients and build long term relationships.” www.apfsbilling.com THE SUIT MAGAZINE p.27
Page 1 and 2: Issue 63 NOV 2014 Top Billing Docs
Page 3 and 4: publishers note ISSUE 63 | NOV 2014
Page 5 and 6: BUSINESS / FINANCE 34 Technology Se
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Page 9: By exposing such massive variations
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Page 24 and 25: Alternative medicine emerged as con
Page 28: y rich monetti NEVER MAKE the Same
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Page 33 and 34: y peter suciu Compliance is Key for
Page 35: their needs are, but still require
Page 38 and 39: y enid burns HELPING SMALL LENDERS
Page 40 and 41: y amy m. armstrong Employee non-Com
Page 42 and 43: y g. levin Health Agent says Everyo
Page 46 and 47: y amy m. armstrong Providing More t
Page 48 and 49: EARLY IDENTIFICATION OF LD AND ADHD
Page 50 and 51: y rodric j. bradford Commitment to
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Page 54 and 55: y mary minor davis Offsetting the T
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explained Travis. “And then I rea
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