Breaking it Down: Analysis of billing options for Group Practice Print
Written by Amy Monagan   
Sunday, 08 August 2010 10:59

When it comes to payers in the health industry it's no secret that they have a tendency to withhold payment or underpay. With the national average of accounts receivables aged over 4 months standing at 17.7%, I think it's safe to say that everyone understands the need for billing management. However, when it comes to billing management there are a few different options that a provider can choose.

A physician can go online to Craigslist, find someone who has a billing background and knowledge of their software, and hire that person to be the in house biller.  This allows the physician tight supervision and transparency of work that is done.  On the other hand, I caution that you ensure the person hired has a fully working knowledge of billing.  I was speaking to an in house biller a few weeks ago and he honestly had no idea what a claim modifier was. Another consideration, will the in house biller have enough time and resources to follow up on every claim and every underpayment? While I am not trying to dissuade you from hiring your own biller, I'm simply giving you a bit more knowledge so you can be better informed when it comes to the billing operations in your practice.

The second option, a physician can choose to go with an outside billing company that uses the physician's technology. These tend to be smaller companies that will come to your practice and build the personal relationship with you and this has a very comforting effect. It's nice to have a relationship with the person who is handling the livelihood of the business.  The downside to this option is the limited resources. Being a smaller company they have X number of employees that can learn only so many systems.  It's difficult to learn and fully grasp different types of billing software for each client.  Also, do they have the resources to follow upon every claim and underpayment, what if that person goes on vacation or gets sick, who will follow up on your claims?  If you do choose this type of billing service remember to do your homework. There is no certification process in starting a billing company, just Google "how to start a billing company" and you'll get step by step instructions. So again, a little homework goes a long way if you choose this option for your practice.

Lastly, a physician can choose to go with an outside billing company that uses their own technology. These tend to be larger companies with hundreds of clients and hundreds of employees.  It goes without saying that the personal relationships with your biller diminishes greatly, but the personal service isn't completely gone.  The physician will have greater supervision and transparency than with the former due to reporting systems already in place. The technology allows for follow up on every claim whether the underpayment is larger or small. These larger companies are designed to level the playing field with the payers; they understand your contracts and what you are owed for your services.

Whether the physician chooses to go with either type of outsourced billing company, take a look at the % of their claims still unpaid after 4 months.  If it's higher than the national average, you may want to continue your search. Reason being, after 4 months it is unlikely that claim will be paid, so the higher percentage tells me the billing company isn't going to bat as often as they should. In today's economic times every penny counts and I would want my billing company to go after the money I'm owed.

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Last Updated on Sunday, 08 August 2010 11:15