The Smart Medical Practice

Calculator or Stethoscope: Which Do You Choose?


medical billing servicesWe’ve yet to talk to a physician who went into medicine because he or she wanted to run a billing department. But plenty of doctors find themselves doing just that. The biggest reason is a mismatch between theory and reality.

In a perfect world, physicians would focus all their time and energy on treating patients, but without someone at the helm of billing it wouldn’t last long. Even in rural health settings where payments are capitated and simplified, the effort required to put the reports together to get paid still requires an appreciable amount of time from someone who’s knowledgeable of the complex reimbursement requirements for RHC’s (Rural Health Clinics) and FQHC’s (Federally Qualified Health Centers).

Outsourcing the billing activities can provide a pre-fixe solution, but in actual practice, moving your physician billing to an outside company can feel a bit like asking a total stranger manage your personal checking account, and hiring the wrong medical billing service can mean putting your livelihood in jeopardy.

The Emergence of EHR / Revenue Cycle Management (RCM) Software
Software companies that offer a marriage of EHR and RCM technology have begun to build a strong bridge between the elements of clinical documentation and medical coding that streamline the entire medical billing process by uniting charting, coding, and payer rules through software intelligence –even to the point of improving bottom line revenue and increased net profit. By turning medical billing into software science, RCM service companies that offer a unified EHR are able to achieve first-pass claim acceptance rates superior to what physicians can achieve on their own at a cost that is respectably below in-house billing departments, making successful outsourcing more common –even advantageous.

Still, when broaching the topic whether to insource or outsource your medical billing, there are very real practical and emotional barriers to overcome. Let’s look at the pro et contra of hiring the services of a medical billing company.

Medical Billing Outsourcing Pro’s

Pro 1: Experienced billers. The majority of physicians have trouble finding experienced billers, and where they’re available, they command salaries that stretch physician budgets. That’s one reason we find so many inexperienced billers (two or three years) in physician offices—yes, they only cost $20 or so an hour, but they’re likely costing a lot more in lost revenue. In contrast, workers at most billing services have a minimum of five years of experience. That means they’re well trained to be highly efficient and extremely accurate.

Pro 2: Lower overhead. Yes, the billing service takes a percentage of collected fees, but the physician no longer pays salaries, buys equipment, or deals with personnel issues.

Pro 3: Smoother cash flow. A billing company guarantees bills will be submitted within a certain time period and followed up on regularly, so cash flow is no longer affected by sick days or vacations.

Pro 4: Improved customer service. Rather than a busy receptionist trying to understand and relay complex billing questions to a billing staffer, a billing service ensures patient questions are answered promptly and billing issues are handled correctly every time.

Pro 5: Improved bottom line. A billing service is incented through its contract to help collect greater amounts of income by reducing errors and denial rates. This is in sharp contrast to in-house billers, who tend to put aside problems in favor of the easier work of clams submission.

Medical Billing Outsourcing Con’s

Con 1: Loss of financial control. In the past, physicians often did experience a loss of control, forced to read a monthly report to understand the status of claims, collections, and mysterious write-offs. Today, cloud-based technology gives physicians complete access and visibility into every aspect of the process. They can check AR levels, denial rates, and the status of any claim 24/7 from any device that connects to the Internet; in a cloud-based setting, blind trust is replaced with transparency into all billing activities.

Con 2: Poor response times. Physicians who fail to fully vet the billing company they choose may experience poor customer service (e.g., phone calls not returned promptly, delayed or missing reports). Check multiple references before hiring a firm and be sure to talk to both current customers and the lead biller on your account. Then make sure all service levels are clearly spelled out in your contract.

Con 3: Disconnect between billing and clinical. To avoid spending time on the phone with billers explaining encounters, look for a service that can connect their systems with your EMR. They’ll be able to access your clinical notes electronically to make sure every claim is coded correctly.

The need, bottom line is for physicians to more accurately understand what their in-house billing is truly costing them in terms of time, dollars, and wasted revenue opportunity. And while outsourcing your medical billing is no a silver bullet nor cure all, it is clear that physicians who find the right medical billing company, one that understands revenue cycle management expertly at the practice level, can put away their calculator, sling their stethoscope around their neck, and get back to practicing medicine.

Overview of PracticeSuite Medical Billing Software


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