8140 Mayfield Road, Chesterland, OH 44026
Call Debi Noonan (440) 729-1001
IS A BILLING SERVICE REALLY NEEDED?
Printed with permission from Dave Jakielo
"Why Physicians Should Outsource Their Billing, (Especially Specialists)"
Dave Jakielo, CHBME
The practice of medicine is comprised of numerous specialties. Doctors train for over a decade to obtain the skills necessary to successfully practice medicine in their chosen field. Additionally, they must continually stay abreast of technological advances and the changing protocols in their chosen specialty to ensure they are providing the best possible care to their patients.
You won't find a general practitioner performing a triple bypass on their patients. The skill and complexity of that operation requires a specialist.
Similarly, given the complexity of today's revenue cycle processes, it takes the
specialized skill of medical billing professionals to ensure your practices economic success and compliance with the extreme amount of government regulations. Billing is no longer something someone does to fill in the time between scheduling and rooming your patients.
When I first started in the medical billing field things were much simpler. Payers would occasionally change a rule and give you ample notice to adjust your processes. Denials averaged less than five percent of total claims. Today if you don't have sophisticated claim scrubbing software it's not unusual to have a 35 percent or higher claim rejection rate which requires extensive and expensive follow-up.
The challenges that your internal billing operations are faced with on a regular basis can lead to collection shortfalls and non-compliance issues. Here are some reasons why outsourcing your billing to a professional practice management / billing company make sense. Regulations change constantly which means that dedicated personnel must have the time to read bulletins, interact with payers and attend industry seminars and webinars. Billing managers should be certified to ensure their competency. Coding personnel who have the responsibility for ensuring that your documentation and
coding is compliant with the new ICD-10 requirements should also be certified by one of the accredited coding organizations.
Technology is another major expense for an individual practice. Besides the initial cost of an EMR and Practice Management system you also need to invest in additional software such as a claim scrubber, denial management tools. , Lack of follow up relating to unpaid claims or under paid claims are two of the biggest problems I usually encounter when reviewing a practices billing operation. Follow up is time consuming and burdensome and it seems to be the last thing people get around to if ever.
When follow up isn't done on a regularly scheduled basis it can lead to lost revenue due to “timely filing” requirements. I have also seen contractual allowance adjustments applied to a patient's account even when the practice doesn't participate with the third party payer. It is also getting harder to attract and retain competent billing personnel. The Society of Human Resources states that the cost of recruiting, hiring and training a new employee is at least $4,000. Utilizing a professional billing company eliminates this expense in its entirety.
Professional billing companies offer services less costly than if a practice does their billing in-house. The goal of any billing company is to maximize collections while ensuring compliance.
Given the complexity of the revenue cycle process, practices need full time professionals to handle their billing operations, no longer can billing be something someone will get around too.
Today most physicians are working harder than ever and taking home less revenue due to declining reimbursement and increased expense to collect on a claim. The question every doctor should ask themselves is, “Why should I have the additional burden of running an internal billing operation?”
Finally there are two things for a practice to keep in mind. First you should, “Do what you do best (Practice Medicine) and out source the rest.” Secondly “Never do anything that you can have someone else do more efficiently and at a lesser cost.”
Dave Jakielo, CHBME is an International Speaker, Consultant, Executive Coach, and Author, and is president of Seminars & Consulting. Dave is past president of Healthcare Billing and Management Association and the National Speakers Association Pittsburgh chapter.
Sign up for his FREE weekly Success Tips at www.Davespeaks.com or Text Davespeaks to 22828. Dave can be reached via email Dave@Davespeaks.com; phone (412)-921-0976
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"An excellent billing service should pay for itself by increasing their clients' revenue more than it's fee".
Wayne Redding CEO and founder of Redding Resources
When my company contracted with a twelve physician general surgery group for the second largest hospital in Cleveland, we were able to increase their revenue by 18% in the first year. More than enough to cover my 5% fee (which included postage). This was many years ago, before the hospital required all hospital based physicians to be hospital owned and use the hospital billing service.
How was my company able to increase their revenue? By using the best billing software and having an experienced staff of trained billers. My staff is dedicated to my company and has many years of experience along with the knowledge to work denials and under payments.
Once the word got out of the excellent job my company did for this surgical group, six other departments from the same hospital signed up for my service.
They were: Pediatric Surgery, Vascular Surgery, Cardiothoracic Surgery, Oral Maxillofacial Surgery, Dermatology and OB/GYN. We worked all these accounts for many years, increasing their revenues by at least 10%.
My largest practice in San Francisco told me their account manager was an "Ankle Biter" when it came to getting insurance companies to pay their claims. A nice compliment. They have had the Same account manager for over eighteen years.
Insurance companies are not your friends They will do whatever it takes to deny or under pay your claims. This is why a experienced billing service is so valuable .
2021 Update: In 2020 we contracted with a new specialist practice in Columbus Ohio. They have used three different billing services in the last five years and have lost well over $100,000 due to bad billing. We have cleaned up the mess and have them on the road to being very profitable.
Give us a call today to further discuss how we can make your practice as profitable as possible. We don't contract with every practice that calls. It must be a good fit for both of us to move forward.
Wayne Redding
CEO Redding Resources, Inc.
or
Debi Noonan,
President
(440)-729-1001