Medical Billing Forum

General Category => General Questions => Topic started by: margemib on September 28, 2009, 11:35:02 AM

Title: need some tips
Post by: margemib on September 28, 2009, 11:35:02 AM
I needs some tips on how to get to a office manager when you make a follow up call after sending out marketing brochures, some of the woman that answer the phone give you the third degree and when they find out you are a billing service you can forget it.
margemib ???
Title: Re: need some tips
Post by: PMRNC on September 28, 2009, 12:19:45 PM
Right off the bat you have to ease their minds and ease them into a conversation about THEM and the problems they have.
Never try to go around the Office manager to get to the doctor because you will fail.
In doing follow-up I always ask to speak to the office or billing manager.
Title: Re: need some tips
Post by: margemib on September 28, 2009, 12:59:05 PM
what happens is whoever answers the phone and I ask for the office manager they ask who I am, what's it in reference too and so forth and they cut you off before you get to talk to a manager, like oh we do all our own billing not interested. I was thinking maybe I should just ask for the office or billing manager like you said but not say I have a service just say it is a business call what do you think?
margemib  :-\
Title: Re: need some tips
Post by: Pay_My_Claims on September 28, 2009, 08:30:40 PM
Ring Ring Ring

Hello Dr XXX office
Hello, May I speak to your Office Manager Please
May I state who is Calling

Marge XXX
May I state what this is in reference to?
A) No heffer, you can't
B) Medical Billing Services
C.) A personal matter
D.) I am returning her call

I always try to find out who is the decision maker at the practice. I cheat and look up info on the NPI Registry. A lot of times they will have the owner, or CEO listed. Even on the BBB they have additional information, or I will google the website. A good website has a list of the employees listed.
Title: Re: need some tips
Post by: margemib on September 29, 2009, 02:52:48 PM
Thanks for the tips
margemib
Title: Re: need some tips
Post by: Meli on September 29, 2009, 05:48:44 PM
Ring Ring Ring

Hello Dr XXX office
Hello, May I speak to your Office Manager Please
May I state who is Calling

Marge XXX
May I state what this is in reference to?
A) No heffer, you can't
B) Medical Billing Services
C.) A personal matter
D.) I am returning her call

I always try to find out who is the decision maker at the practice. I cheat and look up info on the NPI Registry. A lot of times they will have the owner, or CEO listed. Even on the BBB they have additional information, or I will google the website. A good website has a list of the employees listed.


I choose A.   ;)
Title: Re: need some tips
Post by: Pay_My_Claims on September 29, 2009, 10:32:00 PM
roflmao...yeah me too,
I just try to circumvent the front desk staff altogether.
Title: Re: need some tips
Post by: PMRNC on September 30, 2009, 06:38:52 AM
I completely disagree trying to get around staff, the office manager or billing manager usually IS the gatekeeper, entrusted with the task of presenting any solutions to the providers (decision makers) that's a known fact. Too often the doctors don't know what's going on and without knowing the problems in the office you can't offer solutions. I've been more successful gaining the trust and conversation from office managers or billers on staff by getting their attention first and empathizing with them. Your goal is NOT to take their job. As a rule I dont' take clients w/out a gatekeeper because I don't want to rely on a busy provider to get me what I need. Your goal is to promote the benefits of using your services, those benefits are NOT just for the provider but for the staff as well as it frees up their time to help the provider provide more efficient patient care. Any time you try to overstep them you will come up empty, remember their job IS to pre-screen calls and they are paid to keep the doctor focused on patients not on taking sales calls. Take the "Sales" out of the call, get the office manager or billing manager to talk.. make them your friend and Allie, show them empathy and give them ideas on how you can help them.
One teqnique I will use is to research certain problems in a given area or by a specific payor and I will call and speak with the office manager, when the person who answer's says.. "what is this in reference to?" I tell them I am a billing company and I would like to speak with the person who does billing about claims that are being routinely denied, or a backup of workers comp, or the new mental health parity laws, or even the new HIPAA (HITECK) provisions. You would be surprised how many doctors don't realize they have very little time to amend their Business Associate Agreements they have with their BA's. Same thing with the Red Flag rules, many offices are not prepared ..the key is to research, learn and talk about these things with the staff. In most cases the staff will be receptive to an empathetic ear, but in all cases they will not be receptive to someone trying to dance around them to get past them, they will feel threatened.
Title: Re: need some tips
Post by: Pay_My_Claims on September 30, 2009, 07:02:42 AM
Well we have to agree to disagree because coming from being an in-house biller and having a billing service come in and explain to you what they can do is JOB THREATENING!! You no longer need your biller that job is GONE. When a service came in, she had us in the meeting and they told what they can do. FULL PRACTICE MANAGEMENT offers scheduling, insurance verification, authorizations, payment posting, denials etc etc. The only position that was clearly safe in that scenario was the front desk staff. The offices that I work now from home don't have a medical biller, except 1, and that is because I only do the DME portion, and the other biller does the Medical side. They could like my services enough to have me do them all, and what purpose would they have to use her, and she actually bills from California.  After that meeting I was clear...well the job you will eliminate is MINES. i did all the auths, verifications, payment posting, denials etc etc. The only person they would need would be the front desk person since they didnt have auto check in and some offices now have that. Don't get it twisted when a Billing Service takes over a practice, jobs are lost. As a business owner, I am not keeping staff on board when I am paying a company to do the same task. What does the in-house biller have to do now that I am there??? Why split the tasks up??

I think the issue Marge is having is that she CAN'T get to the office manager because of the fear of the staff. Her repeat efforts are getting her nowhere. Yes I do avoid the staff because it is the OFFICE MANAGERS job to initially ease their minds of job security. It is my job to work with them should she decide she wants to split the tasks and pay an inhouse-and billing service. I have no idea going in, if they plan to replace the current position, or have me work along side of them. Once I meet with the office manager and tell her what I can do, it is up to them. What happens when you come in, and they replace the in-house biller??

If the Office Manager wants me to meet with the staff and explain to them what my position would be, at that moment a decision has been made that I will be an extension of their office staff, not a replacement. When we have that agreement at hand, that is when I ease the staff's mind, if that can be done. If they think long and hard, they will realize their jobs are still at risk!!
Title: Re: need some tips
Post by: Michele on September 30, 2009, 08:06:10 AM
I agree with both of you - and I love answer "A"!  But I'm afraid that one won't get you to the person you need to speak to.  LOL  Anyway, it is threatening, but if you can get them to let their guard down a little and at least make them feel a little less threatened it helps.  If they like you it is harder for them to hate you.  Another thing you might try is "I'm calling her back about some information on electronic claim filing". 

Michele
Title: Re: need some tips
Post by: margemib on September 30, 2009, 11:51:44 AM
Thanks again, you guy's are so funny!
margemib
Title: Re: need some tips
Post by: PMRNC on September 30, 2009, 02:32:43 PM
I've been at this since 1996 and I have never TAKEN a job from a practice. Yes there are some people that will be so truly threatened they won't put your call through but on the other hand .. it means you have not made them comfortable. Charlene I understand you have that side working within an office but I have spoken to many office managers and billers just like you, however a GOOD medical billing / practice management company WILL utilize the staff, increase production, increase cash flow and most importantly that staff in turn is more productive helping the doctor with PATIENT care. I have a pediatric group who has 8 office staff, I sat with all of them and in one hour they were comfortable, we met again and did job flow studies.. it's 5 months later and the owner of the group told me that their cash flow has almost tripled, they have not had patients stacked up in the waiting room on top of each other like they did in the past, they have missed ZERO referrals, and now they are able to call in scripts to get the patient out the door faster. 2 of the 8 were JUST answering patient phone calls, now they are able to prepare the rooms faster, check patients in and out quicker, even their patients have seen a difference and asked what has changed..   They will all tell you they felt threatened in the beginning but once I met with them they were actually excited.   To those trying to get around the gatekeeper I have to ask as Dr. Phil would.. "How's that working for you?"  It's all in the technique and attitude.  IF you should happen to get a client by bypassing the office staff you are in for a real treat .. NOT because it's not pretty to have someone as the gatekeeper who is resentful of you before you even get to know them, they will make your job twice as difficult, and for what?  ANY office can increase cash flow and run more efficiently without letting staff go, if they can't it means they are not putting patient care first as they should, so outsourcing is NOT just about money, it's about bottom line, efficiency.
Title: Re: need some tips
Post by: Pay_My_Claims on September 30, 2009, 03:04:27 PM
Yes, but its a DEMOTION. If you are now taking over the billing part of the practice, what does the medical biller do??? Check out?? Check in? Medical Records. They may still work there, but they are NOT doing the billing.
Title: Re: need some tips
Post by: PMRNC on October 01, 2009, 07:11:07 AM
Quote
Yes, but its a DEMOTION. If you are now taking over the billing part of the practice, what does the medical biller do??? Check out?? Check in? Medical Records. They may still work there, but they are NOT doing the billing.

Charlene, again, I disagree and it might be your way of thinking because your view is from only one office, there is no demotion, no cuts in pay, the tasks have changed, but everything in the office is relevant to the practice, it's about increasing efficiency and ultimately patient care.. you have to think outside the box, if you focus on trying to be THE only one running the practice you won't get anywhere, the office staff is vital and again, I have not taken anyone's job NOR have any of them received demotions, decreased pay, hours, etc.  If you go in to an office and you are successful in what your goal is the office/practice WILL run smoother...that's not an opinion, that's a fact. If done right the office will gain MORE financial stability, increased cash flow, decreased overhead and again ..most important.. Increased efficiency and patient care... EVEN if they keep their current staff.  But of course, only if it's done right. This is not just an opinion, it's fact.. I've done it and I know MANY other billing companies that will agree with me because they are approaching their marketing the same way.. why? because it works. Of course it doesn't work sometimes but most times that's because the right approach hasn't been taken, or quite simply you have someone that is automatically threatened and won't budge or give you a chance, it's a numbers game but the general and overall consensus of what works is NOT to go around the gatekeeper, not only won't it get you in their office, if you do get lucky to talk with the provider you will have to work with that person you pushed aside... and believe me that's not fun.
Title: Re: need some tips
Post by: Pay_My_Claims on October 01, 2009, 07:58:48 AM
Yes, I do think outside the box, one of the reason's that I do DME. I don't focus on just medical billing. My opinion isn't on just ONE  office, but I made reference to the one that started it to me I can mention others, but it would be a mute point. Again you can tell me from your experience when you went in to do the billing for a practice, what did the biller in that practice do??? If they are not demoted........what are they doing??? I do the AR/Billing now for a DME company. If you take over this business, what would be my job? You will be doing the posting, billing, and reconciliation. What do I do other than fax you information???

puzzled, dazed and confused.
Title: Re: need some tips
Post by: PMRNC on October 01, 2009, 11:48:03 AM
Does your practice see patients? perhaps that is where the confusion lies.. certainly DME companies are going to be operated differently..but in dealing with medical offices that see patients day-to-day there are a ton of things that can be done, from referrals, scheduling, triage, Policies&Procedures, charts, etc... 
I suppose if the DME company you work for is not dealing with day-to-day patient care there are going to be people with nothing to do.. from a marketing standpoint someone COULD present an outsourced solution, cut the practice staff, overhead and save the practice money right off the bat.. especially in today's economy.. all I'm saying is that if you plan to market to providers who do see patients on a day-to-day basis you will still have better luck NOT excluding the office/billing staff or trying to undercut them.. later on if the practice should decide to cut staff that decision would be there's but again, I've never taken anyone's job in all the years I've been doing this. Now if you don't plan to market to practices that don't see patients on a day-to-day basis like some DME companies than perhaps you do have to have an angle to go around the office / billing staff. So how do you do that if you can't? 
Title: Re: need some tips
Post by: Pay_My_Claims on October 01, 2009, 01:11:52 PM
I do both, medical and DME. You basically said what I was saying as well. I personally consider it a demotion when I am not longer doing what I was hired to do. Yes they have other functions in the work place that don't have anything to do with the direct revenue cycle. Large practices do have referral specialist , but non-medical personal don't triage. Offering FPM can include scheduling, referrals etc. In DME we do see clients daily. We do repairs which would be considered something like urgent care. This is very important as you have to recheck benefits, check for DME caps and also check for same or similar. You also have to deal with clients that got their equipment somewhere else or in cases where it was paid by another source and repairs are being done by Medicare. If a billing service came into this office, that is one of the positions that I could do, work in service...not what I signed up for. I think your view is on the fact that the person may not necessarily be terminated because there is work to be done, but i look at it as they no longer need the biller they hired doing the billing function. Even now with me doing the AFO's for the neurologist, and they have a medical biller doing the medical claims. She can't bill DME, but I CAN bill both. How long do you think they will keep us both???  I would hate for her to lose her job, but it is something she is thinking about.

Single mom of 2.......dog eat dog world...I don't plan on being on the inside of the dog looking out!!
Title: Re: need some tips
Post by: PMRNC on October 01, 2009, 01:29:27 PM
Well I don't think we are thinking along the same lines.. you are thinking as an in-house biller vs. Marketing yourself as an outsourced billing company, there's a big difference. YOU might view it as a demotion, but if you plan to market your services you need to not focus on those things, let the doctors or practice owners make those decisions.
Title: Re: need some tips
Post by: Pay_My_Claims on October 01, 2009, 02:44:21 PM
*smile* Go back and re-read that is what I said. I said it isn't my job to put the staff at ease, it is the Owners/PM/OM job. I have no idea what he/she plans to do if they decide to hire my service. When I do go into a business, DME/Medical/Dental, I sell full Practice Management. I am doing that for a psychiatrist (she has no biller in-house, nor had one. she was doing it alone so no job lost). The Pediatrician, same case, however the DME has 2 billers, me and the medical biller. she is now DUPLICATING work, and eventually can eliminate one of us. At the moment she and I work in conjunction with each other as well as her other office staff. As my services increase, she can find it not necessary to have all of us there. My focus isn't on me versus them. I don't go into a business looking to have them see what I can do over them, but what I can do to assist their office. I don't market my business in such a way as to eliminate jobs, but for me it is what it is. If I had to hire someone on my staff today, and I had 2 applicants, one could bill both medical and DME and the other just medical. I would hire the one that could do more. I view that with any business. Why keep on staff when the work is being done elsewhere. One of the key marketing forms I see all the time is how much money a company saves when they hire a billing service over a medical biller, so I don't understand the issue.
Title: Re: need some tips
Post by: PMRNC on October 01, 2009, 03:47:37 PM
Quote
*smile* Go back and re-read that is what I said. I said it isn't my job to put the staff at ease, it is the Owners/PM/OM job

Ok, we are half way there. LOL I understand a little better now. BUT.. I'm not saying you can control what happens after you get the client.. ultimately it will be up to the practice owners, but we are still talking about MARKETING and much of marketing involves sales and sales involves putting the gatekeeper at ease.. it's almost brown nosing 101 and while I can understand no one wants to do it it has to be done. If that gatekeeper is entrusted with screening phone calls and visitors and you don't feel it's your job to put her at ease, you will be limiting your potential market. Yes there will be some you are not going to get around and even if you do there is a very huge likelihood that you will be working with them so it's only to your benefit to put their minds at ease right off the bat.  I have also worked with clients that don't have any staff and it's frustrating, I won't take those clients anymore.

Quote
Why keep on staff when the work is being done elsewhere. One of the key marketing forms I see all the time is how much money a company saves when they hire a billing service over a medical biller, so I don't understand the issue
I'm not sure you are understanding and that's fine, a medical practice is SUPPOSED to be about patient care first.. that's the whole idea that's been lost in our country for a long time. If you don't understand why they would need office staff if they are outsourcing the billing, then your just not understanding all the other duties and functions of the practice.
Jobs shift, responsibilities shift and employees adjust, and the ones I've handled adjust pretty well, their stress levels are way down and they are able to focus their attention to patients and other tasks in the office. Check in and check outs go smooth and you don't have patients sitting on top of each other in a waiting room.  Again this is fact proven.. every one of my practices past & present was able to increase collections and run more efficiently and yes.. make more money just by outsourcing and shifting responsibilities.  As a consultant I used to go into larger offices and do what they call job-flow studies, this is where you take the staff and shift their job description for either a week or two weeks, this teaches tolerance and team-work within the practice. Doctors have paid me big bucks and have seen the benefits of this time and time again.

Title: Re: need some tips
Post by: Michele on October 01, 2009, 07:51:55 PM
I hate to get in the middle, but I just half to say that I try to convince the person that was doing the billing, that will no longer be doing the billing, that now they can focus on so much more.  There job is to work with me/us (the billing company) to make sure we (all) maximize the accounts receivable and increase the efficiency of the office.  They will now have time to concentrate on the areas that need work that they never had time for.  Etc etc etc.  I have never had anyone that didn't keep their job, unless there was another reason they should not be there, and not have enough to do to keep busy, and it wasn't a demotion.  There are always some office staff that don't want you there, but it is really not common, once they don't feel threatened.  THat's why it's so important to win them over quickly.  The one's that do have a problem usually have a personality disorder.  But thankfully we know a lot of good therapists for that!

Michele
Title: Re: need some tips
Post by: PMRNC on October 02, 2009, 06:36:41 AM
Quote
I try to convince the person that was doing the billing, that will no longer be doing the billing, that now they can focus on so much more.  There job is to work with me/us (the billing company) to make sure we (all) maximize the accounts receivable and increase the efficiency of the office.  They will now have time to concentrate on the areas that need work that they never had time for.  Etc etc etc.  I have never had anyone that didn't keep their job, unless there was another reason they should not be there, and not have enough to do to keep busy, and it wasn't a demotion.  There are always some office staff that don't want you there, but it is really not common, once they don't feel threatened.  THat's why it's so important to win them over quickly.  The one's that do have a problem usually have a personality disorder.  But thankfully we know a lot of good therapists for that!

That's exactly what I was saying, going around them is simply not the way to go from a marketing standpoint.
Title: Re: need some tips
Post by: Pay_My_Claims on October 02, 2009, 06:58:58 AM
and I am saying as a BILLER, that it is the job that I want to do. What you don't get is I don't want to be doing filing, referrals etc etc. I had the same experience when I was hired at the Ophthalmologist office. The girl thought I was interviewing for the "front desk" position when I was there to do the billing. Before me, she did check in/out/billing. She had poor customer service and the OPH's AR was TERRIBLE. She couldn't recognize medicaid for Pregnant women so the services were denied since it doesn't relate to pregnancy. When duties were taken from her to me, there was a lot of resentment. Had I come in that office as a Biller and a company came in and took those services away and left me doing medical records etc etc. Even if my pay stayed the same, I would be seeking another job, or at minimal doing what I do now.....starting my own business. I TOTALLY comprehend what both of you are saying regarding working with the staff etc etc. Calling up and being sociable to the person answering the phone is of course good public relations and it can get you into the OM. You are both in agreement but negating to state it clearly, but Michelle has in such a way "the person that was doing the billing that no longer will" convincing them they can do much more. You FAIL to realize that most people that do billing, do it because it is what they want to do!!! I don't comprehend how you can say they don't lose their job when their job was billing and it is now filing medical records????? The girl I work with in the office now is doing the receptionist job along with her other duties. We restructured and what she does now can be done at the front desk so they felt no need to hire anyone. She didn't want that job, she started at the front desk and moved up,now she is back doing it. She didn't lose her job, but she in a sense is demoted. Pay is the same, but job duties have changed. You both own your own companies, and imagine if you had stock, and it was purchased by me. I now own 80% of your business and I don't need either of you as the head of your individual branches. You are no longer owners, but managers..........same thing. Still have a job, its just not what you signed up for.
Title: Re: need some tips
Post by: PMRNC on October 02, 2009, 10:13:45 AM
Quote
I don't comprehend how you can say they don't lose their job when their job was billing and it is now filing medical records?

Because your thinking too much about the "employee" and not about yourself and your business AND also you don't have a clear understanding of the other tasks involved in the practice.. how a practice shuffles the office staff to meed productivity is up to them.. it isn't our job to demote them or move them around.  And if I look at this from someone who is job hunting for a billing position.. right now, in today's job market I'd be lucky to be doing referrals, filling, authorizations, check in's, check out's, appointment scheduling, reporting, audits.. want me to go on? 

I'll say it again.. lol  I"VE never taken anyone's job and I've never had an employee feel like I did or complain about their new found positions because in every practice that I've worked with their productivity, cash-flow and TIME has improved enough to compensate those positions/employees and then some. Another thing is the office morale lifts big time when the billing stress is removed from the office.   

Title: Re: need some tips
Post by: Pay_My_Claims on October 02, 2009, 10:33:48 AM
wow..........actually I do know what runs an office Linda, we just differ. I AM not focused on the employee as it is I that stated it is not my responsibility to put them at ease, it is the OM's job. I also said it is the OM's job to determine how they decide to restructure the office. I totally agree with the fact that jobs are hard to find and anything is better than nothing, but again you dodge the reality (maybe the politician in you) that jobs are "lost" when Billing Services come in. The EMPLOYEE may not be terminated, but that job is indeed taken away. This is my well stressed, maybe not articulated well point. The people answering the phones are guarding the OM as they may have worked previously where a billing service came in, and they lost their jobs. I don't focus on jobs that may be lost when I come in to market to a business. My business is to obtain that contract, and the OM's job as to how they will deal with the added finances that they have to pay. Again i reiterate that on MANY websites you find Billing Services that advertise how much a company saves by hiring a service as OPPOSED to an in-house biller. I am not in dispute that any company that you have "taken over" may not have fired anyone, but again you miss the point....THE BILLER IS NO LONGER BILLING!!  Am I concerned with that...not really, but would I be if I were working at a facility where a service was coming in....YES. Would I trust the service because they state they are not here to take my position...NO. Why because I am more intelligent than that. If you are billing..what am I to do...Yes I still have a job, but I don't have the job that I wanted or came into the company to do. That is fact and not fiction and nobody can sugar coat that any other way.  I think you are very knowledgeable in this business and can offer a lot of sound advice for new and even old billers like me. Please don't get it misinterpreted, I am very, and I mean very well in tune to the ins and outs of the operations of a medical and dme practice.
I guess I will stand as alone as a Biller who enjoys my job and what I do, otherwise I would not be in business for myself. Maybe the ones in your offices may have been happy to get rid of the billing aspect of it, and that is great, but I won't say that this is the case every time because speaking from my heart as a biller.....I wouldn't be happy with the deal. This still doesn't stop me from marketing myself. Its a dog eat dog world!!
Title: Re: need some tips
Post by: Michele on October 02, 2009, 07:56:37 PM
My experience has been like Linda's.  I've never had an employee mad at me because I took their position.  More often they are thrilled because they were overwhelmed and couldn't complete all of their work.  Also, just a thought, if they were doing a bang up job their boss wouldn't have called me.  Just a thought. 

Many of the offices I encounter don't have someone whose only responsibility is the billing and that is the problem.  By hiring me, they can do all their other jobs plus oversee the billing thru me and their hands are still in it.

Michele

PS.  I did have one girl not happy about me coming in, but she was robbing the place blind and knew I would find out.
Title: Re: need some tips
Post by: bobbie on October 02, 2009, 08:26:32 PM
Hey Folks......if we could return to the original question ......you said you sent your brochure to the office. In all likelyhood they got pitched right into the trash if they came by mail. I always go into the Dr's practice and introduce myself to the front desk. I give them my business card and brochure and let them know that I'm a consultant in the area, "I've just been meaning to stop by every time I pass by on my way to my other client's office"(ok, it's just a little white lie). My specialty is Mental Health so lately I've been revisiting those offices and giving them the Federal Parity Equity Act paperwork. Of course I have my business name and ph# stamped on the bottom of the handout. Last week I revisited two offices for the 2nd time and brought in some donuts( not that they needed the calories!) for the front office and told them that I'd stop by next month. They recognized me this last time and were polite. I intend to just keep poppin in on them. I did that at one office I do the billing for now. On about the 3rd visit I asked them if they might need any help on difficult denials or appeals, that I'd be happy to take a look at them. I got a call that afternoon from the office biller who asked me some questions and we've been friends every since. I now do the billing and she runs the office.
My point being, make your visit in person. Leave something behind. Tape your business card to the box of donuts or bring them an alpha filer with your name on it. Tell them you'll stop by again, ask them what they want the next time.....cookies? Candy? Or bring the office a few Halloween decorations.
Eventually they will feel comfortable with you and they will call you. Guaranteed!
Title: Re: need some tips
Post by: PMRNC on October 03, 2009, 09:38:50 AM
Quote
Would I trust the service because they state they are not here to take my position...NO. Why because I am more intelligent than that. If you are billing..what am I to do...Yes I still have a job, but I don't have the job that I wanted or came into the company to do.

I apologize for saying you don't understand all the aspects of the office, it came out wrong.  What I was just trying to say is that you are assuming that every biller hired only wants or is needed to do billing.. this is NOT the general consensus and if it is at first, it's quickly realized that there are so many other tasks to be performed of the same importance to the practice and as Michele and I have both pointed out, it's not just "luck" that we've both had success without taking jobs and like we both pointed out, we're usually able to take out a lot of stress from the office which in turn makes office morale higher and patient's more comfortable. You can't assume that every billing manager is going to go around stomping their feet crying "NO, I want to do the billing" Many think that billing is the lifeline of the practice and really that's not true or it's not supposed to be true I should say.. patient care comes first and anyone hired onto a medical staff should know this.

Back to the topic at hand.. I agree with Bobbi about the personal visits, way better than cold-calling and it's harder for people to be dismissive or rude in person. But as for direct mail, yes if you don't have good materials they will end up on the garbage, but if you take the time to have them done right and professional they won't. I know that when I get really nice marketing's in my mail it's hard for me to throw them away because I think "Wow, this is nice, someone worked hard to put this together and spent the time to make them professional" and I hold on to it. I held on to this one guy's business card which was beautiful (laminated like a credit card and larger than biz card size) and put it in my card file and ended up calling him about a year later and ordering my web server after meeting with him.
I've also had many doctors hold onto my brochure and biz cards and call me many months later. So I would never rule out the power of direct mail.