In an effort to combat the affects of the crumbling economy, service-oriented businesses have been getting creative with new ways to generate money.

Unfortunately for consumers, that creativity often translates into price hikes, additional fees, reduced services or cut backs on productivity. But does it have to be that way?

Take a look at the airline industry. When fuel prices soared last summer, airline giants started charging extra for what were once common courtesy services in addition to the original ticket price. They started with charging for snacks and drinks and then quickly moved onto charging checked bag fees, assigned seat fees, fuel surcharges, curbside check-in fees, etc.

Once the industry giants established that this additional fee policy was going to be part of the standard flight-booking procedures, it didn’t take long for all of the airlines to jump on the “Hidden Fee Bandwagon.” From a customer’s perspective, it seemed as though the airline industry as a whole started seeing dollar signs instead of thinking about its customers needs. Then along came Southwest Airlines with its clear thinking and its “No Fee Policy.”

In some ways, the accounts receivable factoring industry can appear to be a lot like the airlines industry. Both operate world-wide, both industries should be service-oriented, and both industries are notorious for tacking on extra fees in addition to the basic fee. Much like Southwest Airlines, the factoring industry has a handful of healthcare factoring companies who do not charge extra fees in addition to the base fee. This article will discuss three areas where factoring firms might insert hidden fees.

First and foremost, a business owner needs to understand the basics of how a factor charges for its factoring services. It’s important to note that healthcare factoring firms do not loan money; rather, they purchase a company’s invoices at a discounted rate. This discount rate can be a one-time flat fee, or it can vary depending on how long the factor owns the invoice.

In general, discount rates can be affected by a number of things, including the contractual commitment, the average monthly purchase volumes, the average size of the invoices sold, the number of account debtors (customers) that will be factored and the credit quality of those debtors. Variations in each of these will lead to potentially substantial changes in the fee structure. In many cases, factoring firms will have extra fees in addition to their factoring discount fee. More often than not, these “hidden fees” are disguised as set-up fees, administrative fees and penalty fees.

Set-up Fees
There are some factoring companies that start charging fees as soon as a potential client applies for healthcare factoring services. Set-up fees range from a minimal application fee of $25 to a hefty origination fee of $500. In some cases, factors will add in individual fees for due diligence procedures (i.e. running credit and background checks) and legal documentation fees (i.e. assembling legal documents and filing liens). When all is said and done, a new factoring prospect could be $1,000 out of pocket before knowing if he/she has been approved for funding.

When business owners are comparing and contrasting factoring companies, it’s important to inquire whether the factor charges specific set-up fees. Sometimes, the factor will say yes, and sometimes it will say no. It’s up to the business owner to decide whether or not the factoring services outweigh the start-up costs before moving forward.

Administrative Fees
In addition to application, origination and due diligence fees, some factoring firms charge their clients for the time it takes to compile and ship legal documents, billing for postage, long-distance phone calls, photocopying documents and/or time spent on the computer while assisting their clients. There are also fees associated with funding procedures. Most factors will institute set prices for a same-day wire or an overnight transfer of funds.

When a business owner is contemplating the notion of factoring his/her receivables, it’s important to factor any administrative costs into the equation. Without doing so, a business owner could wind up paying a lot more than he/she had initially anticipated.

Penalty Fees
The last way a factoring firm could potentially squeeze in some additional “hidden fees” is when it assigns fees for various “penalties.” Under this umbrella of penalty fees, a factoring firm could designate fees for misdirected payments, early termination of a contract, aged invoices, expedited funding (within 24 hours or less), not hitting a monthly minimum factoring requirement or going over the maximum allowable factoring amount. In addition, a healthcare factoring firm could also penalize its client by holding onto the funds within the reserve account (cash that is owed back to the client once payments have been received).

When choosing an accounts receivable factoring company, business owners should take the time to read all of the terms and conditions before signing on the dotted line. Entrepreneurs should not be afraid to dig deep into the factoring contract and ask a question when something is unclear. Otherwise, those hidden fees hidden fees will reveal themselves at a point where it’s too late to re-negotiate the terms.

So in conclusion, it does appear that the factoring industry is similar to the airlines industry in that players in both are notorious for charging “extra fees.” The plus side to this realization, however, is that both industries also have some players who stand firm in their “No Extra Fee Policy.” The bottom line-much like when shopping for the best airline deal, it’s extremely important to look at the all-inclusive price, including possibly extra fees, before agreeing to do business with an accounts receivable factoring company.

**NOTE: This article is a re-printed version of what was originally written for and published on eZineArticles.com as well as FactoringInvestor.com.

The medical transcription invoice funding specialists recently stumbled upon an “Open Letter Series” written by AHDI’s 2011 Director, Kristen Hagen, discussing the role of medical scribes in the healthcare documentation industry.

Even though, Ms. Hagen wrote the Let’s Talk About…Medical Scribes Open Letter in February, the information within it is still very relevant for our medical transcription factoring blog readers. Here are some tidbits of information we wanted to highlight:

What is the background of a medical scribe?
“Today scribes are commonly referred to as Clinical Information Managers. The primary function of a scribe is the creation and maintenance of the patient’s medical record, which is created under the supervision of the attending physician. The scribe documents the patient’s history and story through direct observation of the physician’s interaction with the patient as well as the procedures performed, the results of the laboratory studies, and the other ancillary information gathered at the point of care…The demand has traditionally been filled with eager pre-medical students, learning first-hand about the workflow patterns and patient care they will deliver in the future.”

What are the skill set requirements and training required to become a medical scribe?
“Medical scribes may be trained on site or through affordable online distance education programs. Skill sets include strong English grammar, a compelling interest in healthcare and  patient improvement, a strong desire to work in a clinical setting, superior analytical and resource skills, understanding and training in enabling technologies…an understanding of information workflow, attention to detail, keen listening skills, and strong multi-tasking abilities…Scribes are also expected to be well-versed in HIPAA and regulatory compliance, and like MTs, scribes have a steep learning curve, with clinical shadowing required in the post training phase.”

Could this be a stepping stone for medical transcriptionists and others in the medical transcription field? Is this an alternate career path for medical transcriptionists?
“There are similarities and distinct differences between medical transcriptionist and medical scribes, as are there in comparing these roles with any other health information management role…Healthcare will need professionals who have flexible resume of contributory skills applicable to an EHR-centric documentation setting. Scribing is a potential alternate documentation setting for medical transcriptionists.”

Ms. Hagen’s two-cents:
“I can tell you that transcribing and scribing are neither competing nor complementary. They are quite unique, with some overlapping fundamental training but with divergent connection to technology and practical application. They are simply two of the many current and evolving roles available for those who seek career in the documentation of healthcare encounters.”

Q: What do you think about the medical scribe industry?

CDIA (formerly MTIA) published an interactive schedule of events for it’s 2011 Conference. The 22nd annual medical transcription and clinical documentation industry conference will be held in Charlotte, NC April 13-16.

According to CDIA’s web site, those interested in viewing the interactive conference schedule can click on the session titles on the page to read the session summary and speaker bio.

(NOTE: Not all sessions are currently clickable, as CDIA is still collecting information from speakers and finalizing the schedule. Please check back frequently for updates.)

According to a brief write-up in March’s issue of Plexus, MTIA will once again offer a morning of education sessions that are specifically aimed at practicing MTs on Saturday, April 16, in Charlotte, NC. Available for a special price, medical transcriptionist attendees will learn:

• ICD-10 Implementation
• Revenue Cycle Process
• Meaningful Use

MTs can choose between two different registration options:

• MT Package #1 - Saturday morning classes only 9am-1pm; and
• MT Package #2 - Saturday morning and the closing reception of the MTIA Conference scheduled for April 15 from 5:30-6:30pm.

MTs must register using the MT Package Registration Form: http://www.mtia.com/downloads/MTIA2011_MTPackage_RegForm.pdf).

Last week, Transcend Services, Inc. announced that is was entering negotiations to acquire DTS America, Inc. The transaction is expected to close next month.

Transcend Services, Inc. is a Nashville, TN-based medical transcription company that serves approximately 30 hospitals, plus a number of clinics and surgery centers in 13 different states.

Andrew Miller, Jr., CEO of DTS America was quoted in the press release saying: “In order to continue our ambitious growth plans, DTS needed to find a larger partner that both recognized the value of our employees and was committed to providing excellent customer service. I believe Transcend is the best partner for our employees and clients and I am excited by the capabilities that each of  us brings the other.”

Click here to read the entire press release: Transcend to Acquire DTS America.

Back in August, it was rumored that the Medical Transcription Industry Association (MTIA) was going to change its name to the Clinical Documentation Industry Association (CDIA).

The CDIA made the official announcement on February 21 at a private press briefing and reception at the HIMMS11 Annual Conference and Exhibition. The name change reflects the fact that the transcription profession is evolving into an editing funding with the advent of EMRs.

Under its new name, the CDIA will continue to promote the value of clinical narrative in capturing information-rich health stories that can be tagged and re-purposed to meet criteria for use and distribution in the EHR.

Click here to read more on the CDIA Name Change Announcement.

The Medical Transcription Industry Association recently published a 2010 Industry Review on its web site. For the benefit of our medical transcription readers, we have included MTIA’s review below:

Membership

• Hosted successful 21st Annual Conference, appropriately themed “Change: New Bonds. New Purpose.” in Daytona Beach, with over 200 attendees and 30 exhibitors
• Responded to membership by reducing 2011 conference pricing structure, making it more financially accessible to small and mid-sized MTSOs
• Awarded Sten-Tel, Inc., the MTIA Industry Support Award
• Approved name change of Clinical Documentation Industry Association (CDIA) to more accurately reflect the rapidly changing healthcare documentation landscape that is no longer limited to traditional dictation-transcription, thereby increasing the relevance of the association in the health IT sector and positioning it to attract new membership
• Launched new electronic Health eBrief: Clinical Documentation Newswire in November, offering members greater diversity of industry sector news and efficiency of delivery

Advocacy

• Maximized the expertise of the Dewey Square Group and MTIA resources, eliminating the guesswork of how to tackle policy issues, resulting in a high-impact coordinated effort
• Met with the offices of 47 Republican and 46 Democratic federal legislators during the 5th Annual AHDI-MTIA Advocacy Summit in March 2010, encouraging them to support efforts to have the dictation-transcription process acknowledged in the “meaningful use” regulations
• Gained the participation of over 600 AHDI and MTIA members who sent letters to their legislators in support of their colleagues who went to Capitol Hill
• Submitted testimony requesting Congressional support of our key roles and challenges, which has raised awareness about industry related issues and will continue to make the case for the value of narrative and our risk management contribution as rules and regulations around certification and future iterations of meaningful use are crafted
• Bolstered legislative relationships and better educated key congressional members on the work that the medical transcription industry does and the challenges it faces, with congressional visits hosted by members (MedQuist and Transcend Services, Inc.)

Sponsorship

• Joined Association for Healthcare Documentation Integrity in promoting the Power of 10 campaign, pledging a commitment to ongoing year-round advocacy.

Board

• Elected 2011 Board of Directors: Robin Daigh, VP, Marketing and Business Development, MD-IT; Dale Kivi, Director of Business Development, Future Net Technologies Corp.; Lee Tkachuk, CEO, Keystrokes Transcription Services, Inc.; Nick van Terheyden, MD, Chief Medical Information Officer, Nuance; and Linda Yaniszewski, CEO & President, ExecuScribe, Inc.
• Hosted CDIA Vision Framework Building session at Q4 meeting, focusing on reenergizing and strategizing CDIA’s vision, mission, and values to augment membership engagement and expand growth opportunities
• Held joint meeting with AHDI and AHIMA executive board members to explore future collaborative ventures and potential for promoting mutual efforts

Brand Building

• Moved the needle forward in growing the visibility of the industry sector among policymakers, regulators, and key healthcare associations
• Released the Ethical Best Practices Manual for the Healthcare Documentation Sector, Speech Recognition Adoption Guide, and Healthcare Documentation Quality Assessment and Management Best Practices, in partnership with AHDI
• Linda Yaniszewski featured in Healthcare Financial Management Association’s supplement Your Outsourcing Strategy as a result of the Chicago media tour
• Joint CDIA and AHDI executive leadership met with U.S. Small Business Administration officials to further efforts in small business development, job training, and competitiveness of workers
• Developed CDIA Strategic Marketing Plan for implementation in 2011

Every month, the Association for Healthcare Documentation Integrity (AHDI) offers educational webinars. Two that the association is encouraging its members to attend are:

Your Association, Your Benefits: An online presentation that details AHDI member benefits and how to take advantage of them.

Steps to Credentialing: A web presentation that explains in detail how to become credentialed.

There are even more complimentary webinars to choose from on AHDI’s Online Store under “Meetings/Webinars”.

Per Mashable,

“Nuance, the maker of popular speech recognition apps such as Dragon Dictation, is releasing the Dragon Mobile SDK to members of the Nuance Mobile Developer Program. The SDK will enable app makers to add speech transcription capabilities to their iOS and Android applications.

The SDK is free of charge and lets developers add speech-to-text translation capabilities in eight different languages, as well as text-to-speech functionality in more than 35 languages.

Nuance’s suite of Dragon Mobile applications is widely recognized as best-in-class when it comes speech transcription, and the SDK is already being used by companies such as Ask.com. The SDK should help robust speech-enabled apps become more prevalent, and we look forward to seeing what developers can dream up.

Nuance has been working on speech-based services since the early ’90s. The veteran company has made a number of acquisitions in recent years, including startups like Jott and SpinVox.”

MTS Transcription Services (MTS) recently issued a press release on how medical transcription outsourcing is beneficial to physicians.

The press release listed out a number of medical transcription outsourcing services features, namely:

• Automated electronic report disctribution
• Document flow management system
• Electronic medical record solution
• Web-based file transfer
• Digital handheld recorders
• Customizing and maintaining EMR
• Secured FTP (File Transfer protocol) with an FTP software package
• Retrieval of completed records using a secure VPN (Virtual Private Network)

In addition, the press release touched upon multiple benefits that medical transcription services offer physicians:

• Reduces overhead costs
• Quick turnaround time
• Complete data security
• Savings in costs - up to 40-60%
• Assured data quality
• High level of accuracy
• Confidentiality of data
• Reduce capital costs of infrastructure
• Availability of services 24/7
• Improve office effeciency
• Ability to create backup copies of patient records

NOTE: If the MTSO works with a medical transcription factoring firm, the medical transcription service can offer extended payment terms to the physicians they serve.