May 11, 2026 Office Hour: Insurance EFT & Billing Roadblocks

Insurance Claims Processing Challenges Charu expressed frustration with processing EFTs and handling insurance claims, particularly with United Healthcare and Oscar, despite following provided instructions. Charu mentioned that Athena had reached out with some support but was still experiencing issues, and she was considering hiring a billing company to help with the EFT connections. Insurance EFT Enrollment Challenges Charu discussed ongoing challenges with enrolling insurance providers for electronic funds transfer (EFT), encountering issues with multiple insurance companies including Aetna, Optum, Oscar, and Echo. Despite following detailed instructions from Athena and the insurance providers, Charu faced consistent errors where the entered information did not match records in the systems. Florence suggested creating a case with Athena and verifying information directly with the insurance companies to identify if the issue lies with Athena's system or the insurance providers' records. The team suspected that the insurance companies might still have Charu's information tied to her previous job location, which could be causing the enrollment issues. Insurance Follow-ups and Patient Challenges Charu discussed following up on insurance cases, including one that was created last week and two others that require calling 1-800 numbers. She planned to complete these tasks during a break between end-of-year and graduation parties for her daughter. Charu also expressed frustration about a challenging patient visit where a new patient arrived unprepared for their cognitive assessment appointment, leading to a delayed end time of 6:30 PM despite the scheduled appointment ending at 5:20 PM. Florence shared similar experiences with unprepared patients, particularly those referred for memory loss issues, and described her approach of conducting quick exams and requesting family members attend follow-up visits. Cognitive Assessment Billing Procedures Charu and Florence discussed billing procedures for cognitive assessments, particularly focusing on the AD8 questionnaire for dementia screening. Florence explained that she bills using codes 04 or 05 for memory decline visits and includes the AD8 as part of a comprehensive evaluation. They discussed the limitations of their Athena EMR system, noting that while it contains some screening tools, they prefer using paper forms for certain assessments to enable easier comparison and tracking of patient scores over time. VA Management and Boundaries Discussion Charu discussed her experience managing patient visits and setting boundaries, particularly regarding cognitive testing and medication refills. She shared that her new VA has been working independently for three days after only a week of training, handling patient documents and urgent messages effectively. The discussion concluded with Charu seeking advice on setting up phone access for her VA, with Florence suggesting she could use an existing unused line rather than adding a new extension, and explaining how web-based VoIP systems work for remote VAs. VoIP System and Billing Challenges Charu discussed her challenges with VoIP systems, specifically using GoTo, which is integrated with a problematic 3-year contract that limits her ability to switch to Microsoft Teams. Jennie and Florence provided advice on delegating tasks and learning to focus on core business activities rather than technical details. The conversation also covered billing processes, with Florence sharing her experience of having an office manager learn billing from the ground up by starting with a small number of patients, which Charu noted as a potential approach for her own situation. Business Schedule and Support Challenges Charu discussed challenges with maintaining a consistent work schedule while managing a new business, expressing the need for more structured hours, particularly on weekends. Florence suggested focusing on specific areas of confusion and recommended signing up for revenue coaching to address questions efficiently. They also discussed issues with Athena's customer support and explored the possibility of upgrading to a higher-tier billing package, with Florence advising Charu to consult with their CSM about potential promotions before making any changes. Athena System and Medicare Codes The group discussed challenges with the Athena system, particularly around claim submission delays and testing requirements. Florence shared information about a new Medicare code G3002 for chronic pain management, which requires a 30-minute session using a validated pain rating tool like the Ping scale. The discussion also covered the G2211 code for longitudinal care management, with Jennie explaining that it applies to patients with chronic conditions where the provider benefits from an established patient relationship. Obesity Treatment Partnership Discussion Jennie and Charu discussed CBT codes for obesity treatment, with Jennie confirming they are available in Kajabi under the resource library. Charu explored the possibility of partnering with a pharmacy to provide GLP-1 medications to patients at a lower cost than competitors like Him and Hers and Ro, while also offering educational services. Jennie expressed concerns about compounding pharmacies but acknowledged the potential cost-effectiveness of this model, which would involve charging patients a fee for visits while marking up the medication cost by only 20-30%. Medical Practice Management Strategies The group discussed various aspects of medical practice management, including revenue strategies for GLP-1 prescriptions and med spa services. Jennie shared her experience with implementing AI tools like Comir for medical documentation, noting its ability to format and populate ICD-10 codes in eClinicalWorks. Charu recommended a less expensive alternative called Whisper Flow for dictation.