WHAT EVERY PRACTITIONER NEEDS TO KNOW WHEN SELECTING A MEDICAL BILLING COMPANY
Reasons
Doctors Outsource
Losing Control
Patient Relations and the Billing Company
How Billing Companies Charge for Services
A Few Points About the Service Agreement
BENEFITS of Outsourcing
THE TREASURE COAST MEDICAL BILLING SOLUTION
Since account
receivables, revenue, and cash flow are integral components of your
practice and the future success of your business, it is extremely
important that you do some research and ask the right questions in your
selection process. Lets
review key questions to ask your prospective billing company here, and
we can elaborate on these areas later on.
- How long has the company
been in the medical billing business?
- What are their long-term
company goals?
- What specialties have they
been billing for?
- Request a reference list.
(Call those doctors)
- How do they charge for
their services?
- When are you invoiced?
What are the terms?
- Are there one time set up
fees?
- Do they charge a separate
fee for per claim electronic clearinghouse charges?
- Do they bill your
patients? Do they
charge separately for this?
- Do they work with a
collection agency on your behalf?
- How do you get your data
to/from the billing service?
- Where do your checks go
from the carrier? (Your office of their P.O. Box)
- What additional services
may be offered? Ex: consulting,
credentialing.
- What type of
agreement/contract do they have? (Question out clauses and fees)
REASONS DOCTORS OUTSOURCE
There
are many reasons, but the main reason is CASH FLOW.
Cash flow is halted due to the loss of a key employee who handled
the billing function. Oftentimes
that employee cannot be replaced today cost effectively.
In addition, expenses that relate to billing and its associated
personnel have skyrocketed. This
expense eats away at your practice profitability.
Consider the cost of the following
expenses as you make your decision:
computer hardware and software maintenance and upgrades,
personnel costs include salary, sick time, and vacations. Cost of
supplies examples: patient
bills, envelopes, HCFA 1500’s, postage, electronic clearinghouse, and
telephones. Lastly, consider your time in the management of all this.
How could you be better using your time to increase patient base?
LOSING CONTROL
It
is the belief of many doctors that outsourcing billing causes them to
lose control of their practice and their receivables.
This belief is false. The
billing service can set up your routine daily controls as you would in
your own office and enable you to still maintain control through the use
if daily, weekly or monthly charge reports and daily, weekly or monthly
reports for receivables. The
Doctor has the capability to review every encounter with a report to
insure accuracy. In addition, all checks/eob’s can go directly to the
Doctors office. Again the
Doctor and /or his staff member can see exactly what is being paid and
what is being denied and why. This
also allows you to deposit funds immediately into your practice account,
as you would have done prior to outsourcing.
Through the use of
aging reports, and collection reports, you are able to keep abreast of
your insurance receivables and self pay receivables.
The billing service will advise you of accounts that they
recommend for collection and the choice is entirely yours.
The billing service will maintain professional courtesy and
discounts as you request them.
The Doctor remains in control as much as he/she chooses to, as time permits, or he/she can delegate certain controls to a trusted staff member. The billing service wants the practice to feel in control and pleased with the job that they are doing.
PATIENT
RELATIONS AND THE BILLING COMPANY
Many times patients
with larger bill will call concerned about the high amount of the bill
and their inability to pay. The
billing service should offer to set up a payment plan that the patient
can be faithful to and meet without too much hardship, It is always
better to try to work something out with a patient rather than have them
not pay at all and not return to your practice of refer their family and
friends to you.
The
billing service is on the front line with the patient on a phone call;
in the same way your medical staff is in person when the patient arrives
at your office. When your
patient hangs up from the billing service they should have a feeling
that they have had another pleasant, helpful, encounter with a member of
your staff.
HOW
BILLING COMPANIES CHARGE FOR SERVICES
Two
common methods used to charge for billing services are:
-
Flat fees per claim basis
-
Percent of account receivables per month
The
flat fee method was popular when the service business first came into
being. Companies would
charge from $2.50-$4.50 per claim and 50% of that amount for
resubmissions. All other charges would be billed separately.
Example: patient bills, EMC fees, and postage costs.
This method is not widely used today, but it is important that
you are aware of it.
The
number one method used today is the percentage if account receivables in
a given month. This
percentage can range from 5% to as high as 16%.
It is our opinion that 10% and up is on the high end.
If you are contemplating going with a company charging this rate
be sure that there are no additional charges and try to lock that rate
in for a few years. Many
companies will include patient bills, clearinghouse fees, and postage
costs as part of your percentage. This
is an area where you may be able to negotiate.
The one time set up fees range from $500.00 - $2500.00 depending
on the level of work that is required up front.
Prior to the first claim being generated your practice needs to
be set up on computer. This
involves setting up your providers, place of service, provider ID’s,
insurance carrier, ICD9/CPT codes, fee schedules, patient base and
productivity reporting. The billing service needs to contact carriers advising them
of the billing intermediary status on your behalf as well as testing and
getting you set up with the EMC carriers.
Those companies charging the higher rate may be setting up
software for you and or training your staff along with some consulting
services.
A
FEW POINTS ABOUT THE SERVICE AGREEMENT
It
is important to both parties that if in the event one party is unhappy
with the other that provisions are made to get out of the agreement.
This would be in the form of a termination out clause.
We favor the open-ended 60-day written notice that each party
could exercise. Be aware of costs that may go along with an out clause and be
sure you will be able to obtain all of your receivable data in the event
of a termination.
Another
important area of your agreement is the invoicing/fee schedule area.
This area should state how your fee is calculated.
It should say when you will be invoiced and the terms of that
invoice. If the company
charges interest, that should be stated as well as the percentage and
how it is calculated.
Some
agreements have additional provisions clause.
Additional provisions would be anything over and above normal
billing that you may require or that you negotiated separately from the
billing fee. Some examples
of this would be consulting, postage costs, EMC clearinghouse fees,
software use/installment, staff training, of other special projects that
you may require in time. Some
of these things are considered to be mutually beneficial by the billing
service and may be no cost to a client.
If this is true it should be listed and the fees should be listed
as well. This information
up from will eliminate any unexpected surprise later on.
There
are distinct advantages to outsourcing your billing that including
enhancing income and ensuring cash flow stability.
By combining experience staff and the technologies of today’s
practice management systems, a billing service allows it’s clients
more time to devote to patient care and the growth of the practice while
the service maintains the day-to-day billing operations.
TO
LIST A FEW, SOME OF THE BENEFITS ARE AS FOLLOWS:
-
A virtual extension of your practice invisible to your patients;
-
Prompt courteous resolution to your patients questions or problems without interruption to your staff’s busy workday;
-
Insurance of maximum reimbursement for your services in the shortest amount of time;
-
With in-depth medical coding knowledge a billing service can optimize your reimbursement and assure fast turnaround of your receivables;
-
Provide you with comprehensive financial reports that inform you of the current state of your receivables and charges so that you know exactly where you are at any given time;
-
A billing service helps the client to practice more profitability and eliminate the stress associated with in-house management billing and receivables;
-
Compensation through a percentage of receipts is invariably less than the costs incurred with retaining these functions within the practice.
HOW
TO BRING DOWN THE RISING COST OF MEDIAL BILLING
THE
PROBLEM:
Today's
managed care system means…
-
More government-mandated guidelines for fee-setting claims filing and reimbursement.
-
An overall decrease in reimbursement with an eroding patient base.
IT’S IMPACT ON YOU:
-
More time and expenses involved in staying current with constantly changing rules.
-
Maintaining revenue levels is increasingly difficult.
THE TREASURE COAST MEDICAL BILLING SOLUTION
REDUCE
OVERHEAD AND INCREASE PROFITS
Our
medical coding expertise assures maximum allowable revenue for every
patient encounter and procedure.
Electronic
claims processing turns receivables into cash in as little as 7 days.
Faster turnaround means improved cash flow and a more profitable
practice.
Additionally,
Treasure Coast Medical Billing offers expertise in the appeals and
review processes, and handles claim follow-up, as well as all patient
inquiries regarding claims and statements.
HIGH
OVERHEAD COST ELIMINATED:
-
No need to hire and train costly billing personnel
-
No hardware costs
-
No software costs
-
No maintenance, support or upgrade costs
-
No billing-related phone calls or postage costs
-
No interruption of account receivables flow due to staff vacation and absenteeism
THE
RESULTS