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October 13, 2011
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, 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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