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With the many changes in medical billing and requirements, maybe now is the time to evaluate if you should outsource your medical billing, or to keep it in house and improve your technology. There are many questions to ask and areas to evaluate during this decision process. Some of these areas will be very objective while others will be subjective, yet each will need careful consideration.
Am I getting all that I deserve?
There is a cost of doing your medical billing yourself. On average, it costs practices between 4 and 12 percent of the practice’s net collections. Usually in the smaller practices, not only does the person input the claims, they usually do many other tasks for the practice. This can limit their ability to follow up on denied claims, not fully paid claims and insurance collections as well as guarantor collections. Following this logic, you may not be getting all that you deserve for your practice.
Should I utilize a medical billing service?
In some cases a medical billing service can achieve a better an increase in your net collections. In many cases, a practice can see a 5 to 10 percent increase. Since a billing service only focuses on billing and collections, this focus helps drive efficiencies as well as keep the focus on “getting what you deserve”.
What is the positive side of utilizing a medical billing service?
Consider not only the increase in net collections but also the ancillary benefits of a medical billing service. One benefit can be the concerns and issues dealing with employees and employment rules and regulations. With this, you can include the benefits you need to offer to keep “good” employees.
By utilizing a medical billing service, you pass the burden of hiring, training and managing of employees to the service. If employees and employment issues are taking up too much of your time, you should look at utilizing a medical billing service.
Another ancillary benefit is the time it takes to keep up with payer rule changes, government regulations, codes and proper coding. To bill correctly and get what you deserve, you or your employees must keep up to date with the multitude of changes in the medical billing market. Let alone the government and payer changes, this could mean a full time job for some practices.
Since the billing service is the expert, a medical billing service has a staff to monitor and manage all of the changes. A good billing service will have a group that just manages the payer changes to insure only “clean” claims are sent to the payer. By sending “clean” claims, the cash flow of the practice can improve, since there are no disputes on claims and they are paid quicker.
What is the negative side to using a medical billing service?
Your practice has to give up some of the control of the billing process. Although you are giving up some control, a medical billing service that acts as a “partner” with you will allow a total view into their process. By providing the practice the capability to view real-time reports, access the software and the ability to create their own reports; the billing service becomes “transparent” you have a clear view into the process and activities occurring for your practice.
Some practices feel that by utilizing a billing service, they may need to lay-off some of their long-term employees. This will have to be a decision your practice will have to make and it is not an easy decision. What we have seen recently in the market, is that many practices are not laying off employees, rather re-allocating them to different departments or changing their roles and responsibilities. By receiving “what they deserve” a practice can afford to keep the staff working, but in a different role.
What criteria should I use to select a medical billing service?
A billing service should work with your practice and not against your practice. By understanding your practice’s goals and ambitions, the billing service is a team member and strives to meet your practice’s goals. Since the billing service is a team member, you should control the billing service as well as the billing service should be transparent to your practice. You should have the ability to create your own reports when you want to, and to see how the billing service is performing at any time.
A billing service should be on the leading edge of technology to utilize all efficiencies to increase your cash flow and for your practice to get what it deserves with every claim. The billing service should be in control of its own technology.
Finally, who does the claim entry? Many billing services are sending data entry overseas. Is the transmission of this data safe, are they employees of the billing service? These and other questions should be asked of your potential billing service. It may be better to have the data stay in one location instead of many locations.
Am I the only one thinking this way?
Many practices have to think this way to stay competitive. If they are not evaluating their billing options, they may incur issues in these chaotic times in the healthcare market.
If I keep the billing “in-house” what technology should I look for?
First and foremost you should evaluate your process for billing so you can improve efficiencies. Look at each step and see if it is necessary. Many practices utilize new billing software to match their process to gain the “best practice” from the software.
By looking at their process, many practices begin to understand that their billing process may have many unnecessary steps and needs to be revamped. Other practices realize that the process is fine and will only need technology to improve the billing process.
Once your practice understands their process, it is time to find technology, software or both to automate and improve the billing process. Your practice will need to wade through these decisions and understand what is best for your process. Either way, the billing process you use should match and be improved by the software you purchase.
Whatever your process or whatever your decision, you need to evaluate all of your options. If you establish an end goal for your practice, in the long run, you should “get what you deserve” for your efforts with this evaluation.