Posted by Link Grader on Fri, Sep 11, 2009 @ 02:54 AM
Scale is key when selecting a medical billing company. By scale I mean that the medical billing company should have tens and hundreds of providers across whom large, necessary investments can be spread.
For instance, If a $150,000 per year billing system administrator is required, then a medical claims billing company with 200 clients only needs each of its client to carry $750 per year of that person's cost. If a practice of four providers employed this person, then each provider would need to carry $37,500 per year of that person's cost; this is the value of scale. A medical practice can achieve significant advantages by leveraging the superior scale of a mid- to large-sized medical insurance billing company.
A medical billing company should be deploying technologies and resources that a typical medical practice simply cannot afford or support. Examples of technologies and processes that lend themselves to scale include:
- Advanced (and expensive) billing systems that offer state-of-the-art claim management and reporting abilities.
- Pre-submission claim scrubbers that deal with the different rules for adjudication that every unique payer has.
- A good billing system manager that stays updated with constantly changing claim submission rules from different payers. Sometimes claims can go several weeks before getting submitted, simply because many payers change their formatting rules so often. Medical billing companies are less susceptible to such tactics.
- Advanced collection tools, such as predicting payment yields from patients (such as the amount the patient owes times the likelihood they'll pay).
- A well-defined and managed billing process that will not grind to halt because a single employee is lost and eliminates errors before they propagate through the system.
- A dedicated group of individuals that follow-up on claims that have not had a response from the payer within a reasonable time frame.
These and other advantages show that most medical practices can't afford the personnel and technology to match the services that a good, properly scaled medical billing company provides.
Most of the costs associated with the processes and technologies are fixed, and medical billing services spread these costs over their entire client base. A medical billing company that serves a few hundred physicians is more likely to provide better services than one that serves only a few practitioners. What's more, smaller medical billing companies struggle just to use processes and technology that is equivalent of what most practices already deploy.
The bottom line is that it's always a good idea to check the scale of your medical claims billing company. The bigger ones are better able to collect from insurance companies and payers, who tend to do whatever they can to keep their money.
Copyright 2009 by Carl Mays II
Posted by Carl Mays on Sun, Dec 21, 2008 @ 06:29 PM
Outsourcing medical billing to the correct medical billing company can insure that they have the same incentives as you do.
Almost all medical billing companies are paid a percentage of what they collect. This means they are only paid when you are paid. It also means the more they collect for your practice, the more they are paid. Internal medical billers, on the other hand, are almost always hourly employees. They are paid based on showing up in your office, not based upon how well they perform your medical billing or how much money they collect for your practice. This is not an alignment of incentives.
This issue, however, is often not fully understood or appreciated by many providers. These providers frequently say: "the staff works directly for me in my office-- they are more loyal and will do a better job and I can see what they are doing". Experience has shown, however, that this is often not true.
I recently spoke with a partner at a busy cardiology practice. While one of the billers was out sick, some paperwork was required and the supervisor went looking for it. When the supervisor opened the missing biller's desk, a stack of unfiled, old claims was discovered. It turned out about $40,000 of them were past timely filling deadlines. They were lost. I repeat-the practice lost $40,000! When the biller returned from her leave, she was "sternly" reprimanded. Let me say it one more time-she was reprimanded. Not fired, but reprimanded. Either way, the practice lost $40,000 in just this one instance alone.
Why wasn't more severe action taken? Because of concerns with upsetting the billing staff and exacerbating a staffing problem that existed. The biller was moved from follow-up to the front desk where she is now being trusted to collect the critical demographic information required to properly bill claims.
This volume of missing charges should not have gone unnoticed. There should have been multiple reports that could have identified such a problem. The practice, unfortunately, did not know how to properly utilize the capabilities of the billing system and so, the required reports were never run. Proper use of a billing system requires much investment in time and training, an investment that hourly employees often do not make. This $40,000 in unbilled charges is likely a proverbial roach of this practice - in other words, for the one you see there are likely hundreds you do not.
If you select the correct billing company you can avoid nightmare situations like this. Here are some of the key elements you should seek when looking for a medical billing company:
- A fully integrated tracking system (charges by locations/provider and payments by source - lock box, office, PO Box) should be in place and you should have full visibility into the system at all times.
- Your medical billing company should reimburse your practice for what you would have been paid by the payers based on your allowable for any claims that go past timely filing for reasons within the medical billing company's control. What this means is that you never suffer financially if the billing company drops the ball. Try to have your billers reimburse you if they drop the ball.
- The practice should always (24 hours a day, 7 days a week) have access to the medical billing companies system. This allows the practice to see at any time exactly what is happening with their account.
Physicians are working harder for less as costs rise and reimbursements fall. This is exacerbated by selecting a medical billing approach that does not have the proper alignment of incentives to prevent disasters (such as $40,000 in unbilled charges) from occurring.
It has been said that the definition of insanity is doing things the same way and expecting different results. This certainly applies in the story outlined above. The biller that left $40,000 in charges unbilled will likely continue to cost the practice money. Just because she works for the practice does not mean she represents their best medical billing solution.
Selecting a world-class medical billing service that provides total visibility into their process and has incentives that are fully aligned with those of the practice is the most reliable road to outstanding medical billing and financial excellence.
Copyright 2008 by ClaimCare Medical Billing Services
Posted by Carl Mays on Sat, Dec 20, 2008 @ 12:02 AM
The path from deciding to outsource medical billing to selecting your medical billing company requires a well planned selection strategy. A cornerstone of this strategy is well thought out and executed reference checks.
There are many critical stops to make in the journey towards your medical billing company selection. Reference checking is one of the most important stops along the road. There are several steps that must be taken to ensure through reference checking.
Although today's write-up is geared towards creating an effective interview guide, this is far from the only ingredient of a successful medical billing services company selection. Other critical ingredients include outlining the minimum requirements of an acceptable reference (e.g., does it need to be in your state, what specialties are acceptable, etc), deciding if you want to speak with a former client, outlining the roles of the people with whom your wish to speak (e.g., lead partner, practice administrator, day-to-day billing contact, etc), creating the interview guide, call the references, and making the final go/no-go decision.
Your interview guide will allow you and not the references to determine what topics are addressed in the reference calls. If you do not drive the calls, you may well end the process still unsure about your final decision. To kick-off the interview guide creation think about the worst things and the best things that could happen as a result of outsourcing medical billing. Keeping your mind on these best and worst cases develop questions that will help you determine where between these two extremes your potential medical billing company operates.
Narrow questions are typically much better than broad questions for reference checks. Broad questions such as "Did you billing improve after you outsourced?" will not give you specific enough data to make an informed decision when your reference checks are completed.
To insure you have the information you need at the end of the interview process use narrow questions such as "What were you days in AR before you outsourced and how did they change 3 months after you outsourced?" This gives you specific and actionable data.
Have you ever taken notes during a call and afterwards had trouble deciphering them? If you have you are not alone. A good way to combat this is to leave about a quarter of a page after each question (and sub question) to make sure you can write the answers on the same page with the questions. You have one final to-do before you start making calls. Review your questions with the following thought in mind "Will I be able to make a go no-go decision after these calls?" If not, what questions are you missing? Once you know that you have all your questions in order start scheduling your reference checks.
It is critical not to allow a good meaning but talkative reference to keep you from getting all of your questions answered. Make sure they know you have a pre-determined list of questions you need to address. Find out how long they have to speak with you and keep an eye on the clock to make sure you get all of the information you need. You should leave the door open for call backs by letting references know you may need to speak with them again.
You may find that one of your references brings up a point you had not considered. If they do, add the relevant question to the end of your interview guide and call back any individuals with whom you have already spoken to get this additional information.
Following the process outlined above will insure that you gather the factual information required to make an informed decision about your medical billing service.
Copyright 2008 by ClaimCare Medical Billing Services