Here’s my rant on the challenges in operating a physicians billing service. This physicians billing services owner shares her thoughts on the demands and challenges in working with doctors and their medical office staff.
After working in this business many years with some VERY diverse clients (I’m being kind here), I’ve learned that anything that goes wrong in the reimbursement process is the physician billing services fault.
Doesn’t matter how good a job you have done, how much money you saved or recovered, or how much you increased their revenue. Doctors quickly forget the good you have done and regard the physicians billing service as an expense that should to be minimized.
Not Good Enough
I had a practice that I took over billing for that had a lot of issues, messes, and unpaid claims. Revenue increased over 30% after our billing service assumed took over. Accounts receivable were great - probably the lowest this practice had ever seen. But it didn’t matter if there was $10 accounts receivable outstanding - it just wasn’t good enough.
Some doctors don’t understand the reports spit out by their practice management software and you are constantly having to explain how to interpret. And they don’t want to hear the reason claims are getting rejected is because of coding errors on their part, or invalid insurance info provided by the front office. Or need for medical records required by the insurer before the claim will be paid. That’s just some of the challenges faced by the physicians billing service.
Just Blame Me
And when the billing services are outsourced, it is so easy to blame everything that goes wrong on us. When you are not there to defend your billing service, it’s easy to blame every problem on the biller. For example if a physician serves mostly Medicare patients, it’s not the fault of the physician billing services that Medicare reimbursement rates are so low. Your claims are getting paid doctor - you just need more patients that are commercially insured!
My point is some doctors quickly forget how bad things were and focus - even magnify - the smallest issues, many of which are due to problems with their office operations - not the billing services. My philosophy is we concentrate on doing one thing well - and that’s being a physicians billing service and being as thorough and good as possible.
Importance of Correct Info
A lot of the reasons claims are denied is because the patient and insurance information is incorrect or not up-to-date. Most of these issues could easily be addressed by following simple procedures for front office staff who deal with the patients - like verifying the patients insurance hasn’t changed. It’s very important to establish the rolls and responsibilities of the doctors office and the billing service early on.
Otherwise the provider and their staff will take advantage of the billing service and stick you with a lot of tasks that are their responsibility. It’s almost like the physicians billing service is considered some sort of secretarial service to dump all the messes on.
The doctors office is expected to provide a superbill that is legible with the correct diagnosis and treatment codes, patient demographics and insurance information, information on any payments received at the visit, co-pays, and any secondary insurance information.
Many doctors when outsourcing billing are resistant to giving the billing service credit for co-pays. Even though we have to keep up with and many times bill for them because the office doesn’t collect at the time of visit! That’s why its important when pricing your services to take this into consideration. Co-pays for a busy practice can add up to several thousand dollars a month. At a typical fee of 7.5%, this can add up to several hundred dollars for a billing service.
Good Billers are Valuable
I’ve noticed that when I first take over the billing for a practice, the doctor is very appreciative and recognizes the value we add and how much of a difference a good physicians billing service makes. But after a while they tend to forget how good they have it.
And other physician billing services - especially the big ones - tend to bad mouth us smaller billing services and fuel any doubts. They tell them how much more money they could be making , or plant doubts about the current billing service, or how great their new software is. One thing the larger billing services can’t offer is the personal service that a smaller service can.
Maintain Good Working Relationship
That’s why it’s important for the small physicians billing service to maintain good communications and working relationships with the office staff and office manager. It’s helpful to take lunch for the office staff once a month. Use this as a team building opportunity and a chance to reinforce the processes that will improve the billing - sort of a training session.
Many times there is a lot of turnover with a physicians front office personnel - especially if the doctor or office manager is difficult to work for. I know it’s hard to believe but some doctors can be very controlling. I know it’s hard to believe but some providers act like were all just planets orbiting around their sun. But we must remember they are the reason we’re here and the source of our income.
Doctors Have Challenges Too
And in their defense this is understandable. There’s a lot of financial pressure on smaller practices these days. Medicare is reducing payments, commercial insurance is always looking for ways to cut costs. I see every day the remittance a doctor receives and the write-offs on their services.
They have to see a lot of patients during the day to bring in enough revenue to support the practice. A doctors expenses can really add up for a small practice - payroll, liability insurance, rent, supplies, billing services, software, accounting, etc. (I’m sure I’ve missed a lot of expenses here).
I’ve had doctors just throw in the towel, close their practice, and to to work for a large employer because it’s not worth the stress and long hours ... but I digress.
I’ve found there are no short cuts or tricks in medical billing - just experience, attention to detail, and persistence to make sure claims get paid. Many doctors will view the physicians billing service as an administrative minimum wage task - to which I say you get what you pay for! They may not appreciate the value of a good knowledgeable medical billing specialist - until they are not getting paid. That's when the panic starts.
Feb 19, 18 08:57 AM
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Jan 09, 18 08:52 PM
Just starting out and need specific information on how to submit secondary claims. I understand you need EOB from primary. Do you send entire page with
Jan 09, 18 08:36 PM
What claim form would a Home Health Agency use to file a claim for telemonitoring? Response: We haven't had any experience billing for home health services
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