In medical imaging when a procedure is performed, like an x-ray, the images and physician notes are stored digitally in one software system. A report is sent to billing, who uses another software system to assign a code to be able to send the bill to the payer, typically Medicare or insurance companies. This is an important part of the business because significant costs were incurred to provide the services and the incoming revenue is the life-blood of the company.
Recently a radiology group knew that they were having problems with their billing process. The number of procedures was constant but revenues were declining over the previous few months. They needed a way to compare millions of transactions from their billing and image databases. This started the development of software used by Bern Medical to reconcile the billing traffic. Bern uses its proprietary software to reconcile what has been done to what has been billed. This radiology group discovered that over the previous 18 months they had missed billings of $4 million. They resubmitted the charges to the insurance companies and were able to recover $2 million.
Development of the analytical software began in 2009 and undergoes constant revision to improve the algorithms and the results. During the initial development and testing another 12 groups used the services and were able to recover an average of 2% of their annual revenue. In August 2011 Bern Medical, a San Diego based company, was formed to take the services to market across the country. To perform the analysis a provider uploads a data export from their systems to Bern's HIPAA compliant server. Bern then performs the analysis and delivers back a report of missed opportunities and analytics that can help the provider correct the errors going forward.
The founder of Bern Medical is David Fuhriman. He graduated from Boise State University with a degree in Spanish and Economics. He earned an MBA from Northwest Nazarene, is a California licensed CPA, and a Six Sigma Greenbelt. Recently he worked at a fast growing San Diego based telecom company. During his 5 year tenure revenue grew from annualized revenue of $20M to over $160M. David was responsible for business intelligence, financial consolidation and development and maintenance of corporate budgeting.
David says the most important thing is that its services are risk-free and doesn't cost anything out of pocket. "Our proposition is that we provide an independent billing review for free. If we discover that the billing process is perfect, then our clients pay nothing. We only take a fee based on dollars we actually help recover. So it is a win-win situation." When asked if this means that it is an easy sale, David replies, "Yes and no. Many people see the value immediately. When some don't they usually fall into one of two camps. The first is the assumption that they don't have any errors. The second is that they are afraid that we will expose the errors that they have personally made. The answer to both of these concerns is that there will always be errors. We expect to find a 2% error rate. This means that there is a 98% accuracy rate."