October 13, 2011
Question:
Jennifer,
I’m not sure who to go to with this issue, but my practice has had problems with billing. I do not like admitting this, but I do not have the best staff and I am not sure where to start looking to get my practice in order. Any advice?
Dr. C
Answer:
Dr. C, you are not alone. This is a common issue I hear and one that is not always easily fixed. With the time requirements on documentation nowadays requiring your time and attention in addition to patient care, I hear many practitioners expressing they really do not have enough time to truly take command of their practice operations, which leaves the door open to mistakes and other issues with reimbursement. These complaints are common whether the practitioner has in house or external billing personnel. My advice is to take the time to understand what you have going out and what you expect coming back in. At the end of the day, while most practitioners are remiss to look at their practices this way, you are running an account receivable business. And, without your accounts receivables coming in, you do not have a business (or practice). I know this is not news to any of you out there, but most third parties are working against you to receive your ARs. Insurance companies are denying and withholding whatever reimbursement they can get away with, patients are withholding reimbursement they receive directly and failing to pay co-pays and billers are skimming off the top of what you are actually receiving. What to do? What to do? The first step, as I said above, is to understand your practice and get a grasp on your anticipated revenue, and to actively work with people interested in maximizing your reimbursement – and who can do so in a transparent and open process. If you are working with a billing company that does not give you regular reports of where all of your ARs are, you are working with a poor company. There are so many billers and billing companies out there, and in my experience, only a few are worth their salt. When interviewing, I suggest asking about that person’s or company’s process to maximize your reimbursement. Are they familiar with all pre-authorization requirements, do they follow-up with insurers (how often?), what process do they have with the patients? The first 60% of your anticipated ARs are much easier to collect than the last 40%. How do they intend on capturing the remaining 40%?
Some of our most successful practices use a billing cocktail – front office people in-house coordinating with an external billing company, ending with working with our firm for legal collection work against patients and/or insurance companies. This process, including taking action against patients or insurers, may sound aggressive or unnecessary, but we’ve witnessed many clients gain considerably in their revenues from taking a more assertive approach.
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Comments on Finding the right assistance with billing
I received the following helpful comments to yesterday’s email –
Hi Jennifer,
I applaud Dr C for recognizing and wanting to fix what he already knows is not working.
My first question, are his billers up to par? Do they regularly attend Medicare meetings or reimbursement courses with regard to Dr C’s specialty.
Does he par with insurance companies that will pay him what he is worth, w/o the hassle of referrals and such.
Whether billing is done in house or by a billing company, the doctor himself should read @ least monthly reports regarding A/R’s denials, reimbursement levels. My company sends out very detailed reports monthly along with 24/7 access to our program. We are more than happy to print other reports that my be needed any other time of the month. This makes everyone accountable including the doctor. After all, we are all on the same team.
My best practices are those physicians that set a certain amount of dedicated time to go over business issues, because as you stated this is a business and ultimately, you can have a great staff, but if you do not know the fundamentals you will be lost.
Thanks Jen, for a very informative topic that MANY practices face today.
Best Regards,
Cindy
Cynthia Somma CPC, CMM
President
Physicians 1st Reimbursement Services, LLC
584 Ardsley Blvd
Garden City, NY 11530
P 516-292-2027 x 101
F 516-292-2046
VP MGMA -LI CHAPTER
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I agree with you Jennifer, a mixture of outside billing company expertise along with close in-house monitoring can be very successful. Times have changed – payors are increasingly more crafty with holding onto reimbursements, denying claims, assessing a patient co-insurance and even asking for money back once paid finding any reason under the sun to do so!
I believe any practice going through money or billing issues should first have a professional come and take a comprehensive look in order to diagnose the problem. Just like everything in life one answer or solution can’t possibly solve every scenario. At ECM we give that initial consultation free of charge and customize our solutions accordingly.
Louis Burke, CPC
President and Co-Owner
ECM – Solutions for the Medical Practice!
2050 Lakeville Road
New Hyde Park, NY 11040
t – 516.775.8606
c – 917.838.9510
f – 516.775.8618
http://www.ecmmgt.com
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Jennifer,
As practices face downward pressure on reimbursement rates, increasing overhead costs and constant industry changes, it is more important than ever for providers and practices to align themselves with entities that are 100% dedicated to maximizing reimbursement. Unfortunately, it is often not until a practice experiences pain, that they begin to reevaluate their financial situation. In-house billing operations often do not have the resources to ensure maximum reimbursement, as it is extremely difficult to complete all components of the billing process, while simultaneously ensuring compliance, tracking claims, following up on A/R, contacting patients, ensuring accurate carrier reimbursement, providing reporting and assisting with government programs. If a practice’s billing staff is unable to provide even one of those services in an efficient and effective manner, there is undoubtedly money being left on the table. Additionally, if a practice lacks sufficient reporting or the ability to form an estimate of what they can expect to receive based on their billables, it is almost impossible to expect to receive adequate reimbursement for services rendered.
I would have to agree with your point that few billing companies are ‘worth their salt’. However, practices contracting with successful billing companies will tell you that it’s the best business decision they have made. Successful billing companies have been proven to increase revenues anywhere from 5-30%. They are aware of policy changes, cogniscent of provider contracts, meticulous with claim submission, diligent with A/R, and are effective at collecting patient balances. Successful billing companies have the best software and reporting solutions, are ahead of the game with eRx, EHR and PQRS government programs, and are prepared for industry shifts like 5010, ICD-10, and health insurance exchange (which will definitely affect cash flow). Successful billing companies go after EVERY patient balance and are aggressive about recovering the most money possible for their providers. After all, with many billing contracts being tied to a percentage of collections, more money for the provider means more money for the company.
As more individuals enter our constantly changing healthcare system, the business of healthcare is becoming more involved. Providers must begin to ask themselves whether their practice is adequately equipped for this. A billing company could prove to be a valuable ally, preparing the practice for the future and allowing providers to focus on what they do best: patient care. For assistance in locating a reputable billing service, your readers can utilize the Find A Biller tool on the Healthcare Billing and Management Association (HBMA) website (http://www.hbma.org/find-a-biller.php). Please feel free to contact me with any billing questions. Thank you.
Best,
Sidney Haitoff | Project Manager
Medical Management Corporation of America
1620 Route 22, Brewster, NY 10509 | http://www.mmcoa.com
T: 845-363-4839 | F: 845-278-9022 | shaitoff@mmcoa.com
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Jennifer, I read an article regarding the question Dr. C presented from you. You are correct. There are tons of billing services as the India based ones offering 3% or $3.00 per claim, providing horrific services and giving a firm as ours a very difficult road to walk into. You needed to add in the council that these doctors do not want to pay the fee in order to produce the proper quality of work, perhaps by not understanding why this fee is justified. “You get what you pay for”.
Doctors need to understand the cost to process a claim from beginning to end and what it takes for that to be accomplished. If you want to get away with not paying or having that billing service down to the bone on the percentage or per claim basis fee, that is what you will get. It is IMPOSSIBLE to produce for an MD, when the fee you are paid for is so low. This is a BIG problem with billing services. They want the account at all cost. If you cannot have the proper personnel to handle an office DON’T TAKE IT. I have people on a waiting list because I will not take anyone on I cannot produce the proper work for. The most important education to MD’s is the following:
1. Billing Referrals. Speak to owner, not to administrators. These can make deals on “gifts” from services. MD will tell you if that company is
reliable.
2. How many people in your staff will be assigned for the account and their names. Biller / A/R worker and bookkeeper (posting funds)
3. Do you use an outside company for the A/R such as India or the Philippines.
4. How often is the A/R handled?
5. Will they be able to train front desk staff and create policies to work with that billing service.
6. Can the MD and billing service software connects with each other via VPN.
7. If the billing service sales person does not request information on the practice logistics, “careful”. You need to evaluate each practice to find out what that practice will require before committing. This is why a specialist will not be handled the same as an Internal Medicine account.
8. Do they have a coder? How much do they know on the Dx and procedures under that specialty. Each one is different.
9. Will they educate the MD’s on Dx linked to procedures to capture the claim and maximize the income
10. Reports
These are essential questions. We are terrified that companies are marketing us in a way as “get rich and work from home” MISTAKE. This is not a home office. Hiring a home office biller is money down the drain. You need a company with strong network connections. So not everyone that walks in an office is qualified.
I would like to see an article from you regarding billing services. I have a hard road to clean stuff from India and bad USA companies. We take MD’s almost in bankruptcy and turn them around in 6 months into profit again. Hire slow and fire fast. We go into their offices and evaluate personnel. Is not just do my billing.
Please, if you have the opportunity to give other MD’s this information, you will do a great service to us. ECWorks is a strong software company, we are a chosen group for them because of our high bar in the job.
Thank you very much. I enjoy your articles. One of my client forwarded to me. Good job.
Lolita Prieto
Administrator
Trinity Medical Billing LLC
914 358 5703