Doctor's Life Magazine, Tampa Bay Doctor's Life Tampa Bay Vol. 2 Issue 2, 201 | Page 18

Remember that medical billing translates a health care service
into a billing claim. The responsibility of the medical biller in a
health care facility is to follow that claim to ensure the practice
receives reimbursement for the work the providers perform.
Without superior accountability, your biller is likely to let
some things slide. The longer they have done the job, the more
shortcuts they develop. They know how to bury their mistakes
and omissions. You will likely never know about things like:
uncollected copays; write-offs which were made simply because
the biller became too busy to “fuss” over them; and missed
deadlines with resulting dead-filed insurance company claims.
Often business owners manage their billers by observing the level
of their AR. Of course, the AR could be manipulated to $0 if all
the claims creating the AR were just eliminated from sight.
Ask yourself how outside companies can purchase private
practices, continue operating successfully while providing great
patient experiences, STILL PAY the providers the salaries they
were taking before the acquisition, AND make a significant
profit for the purchaser. The answer is very common. The
original doctor/owner had his in-house billing clerks doing
his billing and leaving 30-50 percent on the table with sloppy
billing procedures and follow-up. It is ridiculously common!
Medical billing is no longer the job for just another staffer or
mini-department within a medical practice. It is a demanding
specialty akin to the practice’s legal and tax matters. What
competent business-owner would hire a $40,000 a year
employee off the street to oversee and manage the matters
normally relegated to an attorney or a tax accountant? Yet some
doctors still trust their revenue cycle to a largely unsupervised
in-practice billing clerk with limited proficiency.
There are some practices which have had the same billing
staff for many years. Those employees certainly have experience.
They’ve been doing it for years. The physician often feels a sense
of security with and loyalty to those whom he/she has employed
for a long period. Because of that, the doc is less likely to feel the
need for close staff supervision.
But these questions linger.
»» Is my staff really consistently collecting co-pays before the
OV?
»» How would I know if they are missing filing deadlines?

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Remember that medical billing
translates a health care service into a
billing claim. The responsibility of the
medical biller in a health care facility
is to follow that claim to ensure the
practice receives reimbursement for
the work the providers perform.
»» Do they allow returned claims to sit unattended until they
are worthless?

»» Are they promptly following up with the insurance
companies to push payments through?

»» Do I really have denied or returned claims because of
incorrect coding?

»» Are they submitting scrubbed claims that avoid unnecessary
denials?

»» Are patient balances being pursued or written off too easily?
Is your employees’ tenure a sufficient reason to allow
substandard revenue cycle management? The cost of those
employees can be exponentially greater that their salary and
benefits? Let’s face it, your underperforming billing employees
can very expensive. But there is the matter of the physician’s
loyalty to long-term staffers. In many cases, it is possible to
redeploy an underperforming billing staffer to another position. In
fact, if the biller is not performing well, there is a great chance that
he/she already has some sense of the problem. It may even be a
source of private frustration. Moving the employee to a position in
which he/she can flourish is a win-win for all.
Considering rising personnel/staffing costs and missed revenue
opportunities, it is unlikely that doctors’ in-house billing can
compete with the margin that can be achieved by outsourcing to a
well-priced and high-performing billing company.

Doctor’s Life Tampa Bay

Issue 2, 2014