One City Built to Last

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