DOES YOUR HEALTHCARE PRACTICE GET EVERY DOLLAR IT DESERVES?
How do you know if you are receiving the correct reimbursement for the service you are giving?
At a function recently, I was involved in a conversation with two medical professionals concerning various office procedures. The conversation centered on H.I.P.A.A compliance, the 2006 reimbursement rates and then drifted into the sometimes-complicated world of medical billing. Both doctors had contemplated outsourcing the billing for various reasons and decided to do so. I knew this is often a difficult decision and I asked if things were working out. “Well, things seem to be running more smoothly” and “I’m getting more money in” came the replies. “That’s terrific,” I said, “so how do you know if you are being serviced properly and how does your business compare with others with the same specialty?” There was a long pause with blank stares.
There are many reasons to outsource your billing and there are numerous articles that give all kinds of advice on how to proceed and what to look for. But what happens after you have relinquished control of this activity? How do you rate your billing service? How do you know if you are receiving the correct reimbursement for the service you are giving? Let’s face it; it’s a relief to be able to let someone else worry about all the problems associated with billing as long as it is done properly.
Medical billing service companies range from large Practice Management firms that can employ hundreds of people and do all facets of managing your business to the Home Based Billing business, which may have one or two employees who very often are the owners. In the middle we find “Professional Medical Billing Service” firms that may employ a dozen or so people and are usually agreeable to more customization and personalized service. Some of these firms will also consult with doctors on the most efficient way for their office to run. Many practices enjoy this type of service as it allows the medical professional to be more active in the day-to-day billing operations. This can be helpful in allowing them to relinquish control of cash flow, which can be a very difficult decision. Should you decide to keep the billing process in-house, this type of organization usually offers technical support services to help you through the many changes resulting from electronic updates and changes in the industry. They can help you evaluate the numerous billing and scheduling software programs available.
All billing companies offer a basic billing service package. Beyond the basics, there are a number of options that can be added if required. Some of these may include medical coding, credentialing, medical records software as well as on-line internet access to patient records. Basic services involve electronic claims generation and submission, insurance company follow-up, workers compensation and motor vehicle documentation services, patient statement and various reporting and analysis.
Electronic claims submission includes entry of all patient information necessary to fulfill insurance requirements for successful reimbursement. This procedure not only audits for required claim information but also allows for quicker turn around time for paying claims. Another benefit is the report generator that allows tracking of claims. This provides the required proof of timely filing which can be critical with some insurance companies should the need arise.
Insurance carrier follow-up is not only necessary but can be the most frustrating job for a doctor’s office staff. The enormous amount of phone time necessary to effectively complete this assignment is crucial and should be carried out as soon as possible. It is this level which can determine the financial success or failure of a practice. A high quality efficient Professional Medical Billing firm will have various monitored systems and people in place to follow-up on all denied claims. Ongoing communication between the office and the billing group is essential in this area to effectively manage cash flow.
Depending upon the state your practice is located workers’ compensation, motor vehicle and secondary claims management usually involve unique documentation that can bog down even a highly efficient office. They also involve interaction between lawyers and adjusters and may require employees with unique experience and back ground in this area. These claims on average take longer to reimburse and follow-up is vital to insure a successful outcome. All too often, these claims are forgotten and hence, the medial professional has provided services in which payment will not be received.
Patient invoicing knowledge and a friendly phone smile is essential in this area to maintain a high quality customer oriented practice. Communication between the practice and the billing group is vital in this area to ensure that all patient balances are handled efficiently and properly. This is the one area where patience and understanding can eliminate misunderstandings and problems.
It is extremely important for both parties to review various reports that are available using billing software. These reports provide information that will be useful in order to make decisions relating to the financial stability of the practice. The importance of this review must not be over looked or understated. It is a valuable tool that needs to be incorporated into the weekly or monthly analysis.
Once you’ve compared your billing company with the above standards and you feel confident they are doing a good job for you but you may not be sure where you stand in relation to others in the same specialty. Your accounts receivable, along with an analysis of your insurance and patient aging, will give you a good indication of how well your account is being handled. A properly managed billing company will set goals for your aging based on a number of factors involved in your specialty. The main factor being your insurance mix, which will directly affect your overall aging and how quickly they can recoup outstanding monies. All of these factors are important and will contribute to your overall success.