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 The
practice of medicine is comprised of many different specialties. Doctors
train for over a decade to obtain the skills necessary to successfully
practice medicine in one particular area. Plus they must continually stay
abreast of the technological advances and ever-changing protocols in their
chosen specialty to ensure they are providing the best possible patient
care.
You
won't find general practitioners performing a triple bypass on their
patients which is a good thing, especially for the patients having the
bypass. No, the skill and complexity of that type of operation requires a
specialist.
Similarly,
given the requirements of today's billing processes, it takes the
specialized skill of a medical billing professional to be successful and
compliant. Billing should not be something someone does to fill in the
time between scheduling patients and pulling their charts.
A
decade and a half ago, billing was much simpler. Payers changed the rules
once a year and informed practices in plenty of time so they could adjust
their processes. Denials averaged less than five percent of total claims.
Today, it's not unusual to have a 30 percent or higher claim-rejection
rate, which requires extensive follow up.
The
challenges that internal billing operations are faced with on a regular
basis can lead to collection shortfalls or non-compliance. Here are some
reasons why outsourcing to a billing company makes sense:
· Regulations
change constantly, which means that dedicated personnel must be assigned
to read bulletins, interact with payers, and attend industry seminars.
· Billing
managers should be certified to prove their competency. One such
designation is HBMA's Certified Healthcare Billing and Management
Executive (CHBME).
· Coding
personnel who have the responsibility for ensuring that documentation and
coding is compliant with federal regulations should also be certified by
one of the accredited organizations.
· Implementing
and maintaining a compliance plan can be expensive for an individual
practice; with a professional billing company, the cost of a compliance
plan and the compliance officer can be spread across many clients.
· Technology
is a huge cost center for an individual practice. For example, in addition
to the initial purchase price of payment-tracking software to ensure
proper payment according to the appropriate fee schedule, there is the
ongoing cost of keeping payment tables accurate. Denial management tools
are also required to track and eliminate the root cause of why denials are
occurring in the first place.
· Lack
of follow-up relating to unpaid claims and incorrect discounts applied to
patients' accounts are the two biggest problems I encounter in a
physicians billing operation. Follow-up is burdensome and time consuming.
Because it seems to be the last thing folks get around to, it leads to
lost revenue due to the various payers' "timely filing"
requirements. The second problem is applying a discount to a patient
account after a payment is received; unfortunately, many times a discount
is applied even when the physician doesn't participate with that payer,
which ends up costing the practice hundreds or thousands of dollars.
· It
is getting harder to attract and retain competent billing personnel. The
Society of Human Resource Management states that the cost of recruiting,
hiring, and training a new employee is $3,500. Utilizing a professional
billing company eliminates this expense in its entirety.
· Professional
billing companies offer economies of scale, which makes their services
less costly than if a practice tries to run its own internal operation.
The
goal of any billing company is to maximize collections and ensure
compliance. With the plethora of regulations that now affect billing and
collecting, practices need full time professionals to handle their
billing.
Today
most physicians are working harder than ever before and making less due to
additional regulations and declining reimbursement. The question they
should be asking is, "Why should I have the additional burden of
running a billing operation?"
Finally
there are two things for a practice to keep in mind. First, "Do what
you do best and outsource the rest." Secondly, "Never do
anything that you can have someone else do more efficiently and at a
lesser cost."
Dave
Jakielo, CHBME, is an International Speaker, Consultant, Executive Coach
and Author and is celebrating his 12th year as President of Seminars &
Consulting. Dave is past president of Healthcare Billing and Management
Association and the National Speakers Association Pittsburgh Chapter. You
can sign up for his FREE weekly Success Tips at www.Davespeaks.com.
Dave can be reached via email Dave@Davespeaks.com
phone 412/921-0976.
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