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  • 2-22-2013: The 1974 Superbill Book Publication Written by Bruce W. McKinnon in Hattiesburg, MS and Published by MGMA

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    Bruce W. McKinnon MBA
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    This document (book or “How to Guide”) is a July 1974 publication of Medical Group Management Association / MGMA of Denver Colorado. MGMA is the national association of medical group practice administrators who also belong to affiliated state associations. |||| The publication is a by-product of an idea I had while a member of Minnesota Medical Group Management Association then employed (1969-1972) as Assistant Director of the Medical Education and Research Foundation, a hospital based, multi-specialty group practice of medicine located at St Paul Ramsey Hospital and Medical Center (now Regions Hospital) in St Paul, Minnesota. Before taking that position, I had worked for Travelers Insurance Company in Minneapolis, one of 66 insurance companies to have secured a government contract to process Part B Medicare claims (paid doctors’ bills). The Medicare program had started July 1, 1966. |||| At that time, the insurance / healthcare industry was in a state of flux as more and more people were being covered by private and employer provided health insurance plans. But, each insurance company followed its own internal procedures necessary for third party reimbursement of services under THEIR plans. Providers (doctors and hospitals) were caught between the insurance industry and their insured’s (the patients) who believed that THEIR insurance plan would pay for everything – that it was the provider’s job to see to it that would happen. To secure these payments, doctors were forced to complete each patient’s insurance company claim form, unique to each insurance carrier. This requirement effectively prevented the health care industry from using computers to automate insurance company billing/insurance claim processing. There was little standardization of billing for physician’s services. Doctors’ offices were bogged down in this relatively NEW and rapidly growing phenomenon of filing insurance claims to get paid. Overhead was mounting and people on both sides of the healthcare industry were frustrated. |||| The SUPERBILL concept was really a SYSTEM (series of steps) that physicians throughout the United States could follow that incorporated (1) the capturing of an accurate description of services at each patient encounter using internal “check-off’ pre-coded services & diagnoses (CPT & ICD), pre-priced charge tickets, (2) a copy of which could also be used as an instant itemized patient bill and receipt for payment at time of service, (3) combine service data with patient insurance policy information (retained in a data base), (4) create monthly patient bills to summarize services rendered and (5) generate insurance claims and transmit them (tape to tape direct or by mail) to third parties using ONE standard service rendered format that would be accepted by the insurance industry as a whole for claim processing. |||| Having worked on both sides of the physician / insurance industry (including Medicare), I was easier for me to see the big picture. The concept may sound complicated, but it is exactly what is done today. It assured accuracy in identifying services performed by the physician on behalf of their patients (a serious problem at the time), automate the billing and insurance claim submission process, simplify insurance company internal claim processing and reimbursement procedures, cut third party and physician office overhead and simplify the whole confusing claim process for patients – a WIN WIN for everyone. Easier said than done ! |||| The idea piqued the interest of fellow clinic administrator John Strehlow in 1970. Together, we continued to develop the mechanics of the idea and sell it to the members of the Minnesota Medical Group Management Association (1970 to 1971). The idea hit the NATIONAL scene in 1972 and that led to the publication of the Superbill by MGMA in 1974. The rest is history.

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    2-22-2013: The 1974 Superbill book publication written by Bruce W. McKinnon in Hattiesburg, MS and published by MGMA

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    This document (book or “How to Guide”) is a July 1974 publication of Medical Group Management Association / MGMA of Denver Colorado. MGMA is the national association of medical group practice administrators who also belong to affiliated state associations. |||| The publication is a by-product of an idea I had while a member of Minnesota Medical Group Management Association then employed (1969-1972) as Assistant Director of the Medical Education and Research Foundation, a hospital based, multi-specialty group practice of medicine located at St Paul Ramsey Hospital and Medical Center (now Regions Hospital) in St Paul, Minnesota. Before taking that position, I had worked for Travelers Insurance Company in Minneapolis, one of 66 insurance companies to have secured a government contract to process Part B Medicare claims (paid doctors’ bills). The Medicare program had started July 1, 1966. |||| At that time, the insurance / healthcare industry was in a state of flux as more and more people were being covered by private and employer provided health insurance plans. But, each insurance company followed its own internal procedures necessary for third party reimbursement of services under THEIR plans. Providers (doctors and hospitals) were caught between the insurance industry and their insured’s (the patients) who believed that THEIR insurance plan would pay for everything – that it was the provider’s job to see to it that would happen. To secure these payments, doctors were forced to complete each patient’s insurance company claim form, unique to each insurance carrier. This requirement effectively prevented the health care industry from using computers to automate insurance company billing/insurance claim processing. There was little standardization of billing for physician’s services. Doctors’ offices were bogged down in this relatively NEW and rapidly growing phenomenon of filing insurance claims to get paid. Overhead was mounting and people on both sides of the healthcare industry were frustrated. |||| The SUPERBILL concept was really a SYSTEM (series of steps) that physicians throughout the United States could follow that incorporated (1) the capturing of an accurate description of services at each patient encounter using internal “check-off’ pre-coded services & diagnoses (CPT & ICD), pre-priced charge tickets, (2) a copy of which could also be used as an instant itemized patient bill and receipt for payment at time of service, (3) combine service data with patient insurance policy information (retained in a data base), (4) create monthly patient bills to summarize services rendered and (5) generate insurance claims and transmit them (tape to tape direct or by mail) to third parties using ONE standard service rendered format that would be accepted by the insurance industry as a whole for claim processing. |||| Having worked on both sides of the physician / insurance industry (including Medicare), I was easier for me to see the big picture. The concept may sound complicated, but it is exactly what is done today. It assured accuracy in identifying services performed by the physician on behalf of their patients (a serious problem at the time), automate the billing and insurance claim submission process, simplify insurance company internal claim processing and reimbursement procedures, cut third party and physician office overhead and simplify the whole confusing claim process for patients – a WIN WIN for everyone. Easier said than done ! |||| The idea piqued the interest of fellow clinic administrator John Strehlow in 1970. Together, we continued to develop the mechanics of the idea and sell it to the members of the Minnesota Medical Group Management Association (1970 to 1971). The idea hit the NATIONAL scene in 1972 and that led to the publication of the Superbill by MGMA in 1974. The rest is history.

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    172 visualizzazioni55 pagine

    2-22-2013: The 1974 Superbill Book Publication Written by Bruce W. McKinnon in Hattiesburg, MS and Published by MGMA

    Caricato da

    Bruce W. McKinnon MBA
    This document (book or “How to Guide”) is a July 1974 publication of Medical Group Management Association / MGMA of Denver Colorado. MGMA is the national association of medical group practice administrators who also belong to affiliated state associations. |||| The publication is a by-product of an idea I had while a member of Minnesota Medical Group Management Association then employed (1969-1972) as Assistant Director of the Medical Education and Research Foundation, a hospital based, multi-specialty group practice of medicine located at St Paul Ramsey Hospital and Medical Center (now Regions Hospital) in St Paul, Minnesota. Before taking that position, I had worked for Travelers Insurance Company in Minneapolis, one of 66 insurance companies to have secured a government contract to process Part B Medicare claims (paid doctors’ bills). The Medicare program had started July 1, 1966. |||| At that time, the insurance / healthcare industry was in a state of flux as more and more people were being covered by private and employer provided health insurance plans. But, each insurance company followed its own internal procedures necessary for third party reimbursement of services under THEIR plans. Providers (doctors and hospitals) were caught between the insurance industry and their insured’s (the patients) who believed that THEIR insurance plan would pay for everything – that it was the provider’s job to see to it that would happen. To secure these payments, doctors were forced to complete each patient’s insurance company claim form, unique to each insurance carrier. This requirement effectively prevented the health care industry from using computers to automate insurance company billing/insurance claim processing. There was little standardization of billing for physician’s services. Doctors’ offices were bogged down in this relatively NEW and rapidly growing phenomenon of filing insurance claims to get paid. Overhead was mounting and people on both sides of the healthcare industry were frustrated. |||| The SUPERBILL concept was really a SYSTEM (series of steps) that physicians throughout the United States could follow that incorporated (1) the capturing of an accurate description of services at each patient encounter using internal “check-off’ pre-coded services & diagnoses (CPT & ICD), pre-priced charge tickets, (2) a copy of which could also be used as an instant itemized patient bill and receipt for payment at time of service, (3) combine service data with patient insurance policy information (retained in a data base), (4) create monthly patient bills to summarize services rendered and (5) generate insurance claims and transmit them (tape to tape direct or by mail) to third parties using ONE standard service rendered format that would be accepted by the insurance industry as a whole for claim processing. |||| Having worked on both sides of the physician / insurance industry (including Medicare), I was easier for me to see the big picture. The concept may sound complicated, but it is exactly what is done today. It assured accuracy in identifying services performed by the physician on behalf of their patients (a serious problem at the time), automate the billing and insurance claim submission process, simplify insurance company internal claim processing and reimbursement procedures, cut third party and physician office overhead and simplify the whole confusing claim process for patients – a WIN WIN for everyone. Easier said than done ! |||| The idea piqued the interest of fellow clinic administrator John Strehlow in 1970. Together, we continued to develop the mechanics of the idea and sell it to the members of the Minnesota Medical Group Management Association (1970 to 1971). The idea hit the NATIONAL scene in 1972 and that led to the publication of the Superbill by MGMA in 1974. The rest is history.

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