Updated: Jun 1, 2020
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 practice's economic success and compliance with the plethora 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's management/billing company makes 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. One such designation is the Healthcare Billing and Management Association, CHBME designation.
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.
Implementing and maintaining a compliance plan can be expensive for an individual practice. A professional billing company can spread the cost of their compliance professionals across many clients.
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, and a business intelligence reporting software-while expensive, it is necessary to proactively manage a practice.
Lack of follow-up relating to unpaid claims or under-paid claims are two of the biggest problems I usually encounter when reviewing a practice's 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 economies of scale which makes their 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 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 outsource 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.