Posts
One of the key advantages of billing outsourcing, when it is done correctly, is the clear alignment of incentives between the practice and the billing company.
In most situations (and make sure this is the case for your medical billing service) the billing company only gets paid when the practice gets paid while a practice's in-house staff gets paid irrespective of results. There is also an incentive for the billing company to perform better - the better it performs the more it collects for the practice and in turn the more it earns (and vice versa). This is not true for in-house staff whose wages are typically fixed irrespective of performance and quality of work.
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.
In a recent meeting with a multi-physician provider practice I was told a tale that I have heard many times before. One of the offices multiple medical billers was out for a few days. While she was out her supervisor was looking through the billers desk for some information that was needed. What she found was over $40,000 worth of old claims that the biller had stuck in her bottom drawer and never billed. As if this was not bad enough, almost all of the claims were beyond the timely filing deadlines and the money was lost forever. When the medical biller was back in the office she was reprimanded for this horrendous error. She was not terminated - she kept her job despite the fact the office lost thousands of dollars because of this horrific medical billing performance.
This reaction is surprisingly common. Typically practices have so much trouble recruiting, training and retaining billing staff they are reticent to let one go. In addition, the billing staff complains about how understaffed they are and how they cannot be held responsible for not being able to complete even basic medical billing tasks. In this office's case they moved the biller to the front desk and had her in charge of collecting patient demographics. A place where she can do even more harm through poor performance.
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.
Utilizing a medical billing service that meets the following criteria can help you avoid a medical billing horror story like the one above:
- Complete visibility and tracking of charge and payment batches should be in place. This will prevent anything from "falling through the cracks".
- 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.
- You should have access to the billing system so that you can see real time status of your account.
As physicians struggle with stagnant (at best) reimbursements and escalating costs, it is critical that they make the best possible decision in regards to their medical billing. Selecting a solution that structurally minimizes the risk of poor medical billing is critical.
No - your staff will not work harder for you just because you employ them; and No - the biller who lost you $40,000 will not do any better job collecting money and gathering information from patients. You will probably need to "sternly" reprimand them again.
A high performing medical billing company with complete transparency and full alignment of incentives is the surest path to medical billing excellence and strong financial performance for your practice.
Copyright 2008 by Carl Mays II
In most situations (and make sure this is the case for your medical billing service) the billing company only gets paid when the practice gets paid while a practice's in-house staff gets paid irrespective of results. There is also an incentive for the billing company to perform better - the better it performs the more it collects for the practice and in turn the more it earns (and vice versa). This is not true for in-house staff whose wages are typically fixed irrespective of performance and quality of work.
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.
In a recent meeting with a multi-physician provider practice I was told a tale that I have heard many times before. One of the offices multiple medical billers was out for a few days. While she was out her supervisor was looking through the billers desk for some information that was needed. What she found was over $40,000 worth of old claims that the biller had stuck in her bottom drawer and never billed. As if this was not bad enough, almost all of the claims were beyond the timely filing deadlines and the money was lost forever. When the medical biller was back in the office she was reprimanded for this horrendous error. She was not terminated - she kept her job despite the fact the office lost thousands of dollars because of this horrific medical billing performance.
This reaction is surprisingly common. Typically practices have so much trouble recruiting, training and retaining billing staff they are reticent to let one go. In addition, the billing staff complains about how understaffed they are and how they cannot be held responsible for not being able to complete even basic medical billing tasks. In this office's case they moved the biller to the front desk and had her in charge of collecting patient demographics. A place where she can do even more harm through poor performance.
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.
Utilizing a medical billing service that meets the following criteria can help you avoid a medical billing horror story like the one above:
- Complete visibility and tracking of charge and payment batches should be in place. This will prevent anything from "falling through the cracks".
- 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.
- You should have access to the billing system so that you can see real time status of your account.
As physicians struggle with stagnant (at best) reimbursements and escalating costs, it is critical that they make the best possible decision in regards to their medical billing. Selecting a solution that structurally minimizes the risk of poor medical billing is critical.
No - your staff will not work harder for you just because you employ them; and No - the biller who lost you $40,000 will not do any better job collecting money and gathering information from patients. You will probably need to "sternly" reprimand them again.
A high performing medical billing company with complete transparency and full alignment of incentives is the surest path to medical billing excellence and strong financial performance for your practice.
Copyright 2008 by Carl Mays II
About the Author:
Carl Mays II, President and Chairman of ClaimCare Medical Billing Services, is an expert in the field of medical billing and medical practice management. Carl has been working in the medical field for more than 12 years. Prior to that Carl worked as an aeronautical engineer for Boeing. Read more about medical billing companies at ClaimCare's medical billing blog.
No comments:
Post a Comment