With constantly changing coding requirements and an ever-wider variety of payers and plan structures, many practices find it makes more sense to work with an external billing service. This is especially true for smaller practices that might find their volume is insufficient to justify the expenses of staff and technology to handle the billing.
Outsourced billing can be a wonderful solution to small scale and the challenges of keeping up with billing technology and coding changes. Choose the right billing company, and your practice will benefit from the latest medical billing technology, specially trained staff and the most current knowledge base about coding and payer processes. However, too many practices incorrectly assume that once they’ve chosen a billing service, “billing is no longer our problem.” This attitude can lead to significantly lower revenues than the practice should receive and undermines the very purpose of hiring a billing service in the first place! Establishing an effective working relationship with your billing service – and making sure your in-house team understands their role in the revenue cycle – is critical to getting the most from your outsourcing relationship.
Your biller is part of your team
The first step in creating an optimal relationship with your billing provider is to recognize that your biller is an extension of your team. In fact, to patients calling in with questions or concerns about their bills, the person they reach is your practice. That means that the level of service the biller provides your customers influences patient relationships significantly. A surly, bureaucratic or poorly informed biller can even lead to patient defections.
Ensuring your biller’s attitude reflects your practice’s approach to patient relationships starts with hiring: hold the candidates you’re considering for your external billing service to the same standards you’d use for a new staff member, and choose accordingly. If you’re contemplating working with a large service with no single staffer working your account, be sure you are at least assigned a dedicated representative who shares your customer service philosophy and can intervene if necessary to solve problems.
Remember, too, that keeping your billing team properly informed is essential to them properly serving your patients. Do you have a process for alerting your billing team to changes in your fee schedule or payer contracts? Are your superbills clearly and legibly filled out? Physicians and staff provide the information your biller needs to initiate billing properly and answer patient questions on the back end – make sure the documentation you send doesn’t create needless back-and-forth.
Dedicate a liaison at the practice
Besides ensuring you have a single point of contact at the billing service for your needs, make sure you have a dedicated contact at the practice to help the biller resolve issues quickly. For smaller practices, this might be the office manager; larger teams might dedicate an experienced staff member.
For example, if your billing service is frequently struggling to interpret superbills with unclear descriptions for payments received (copayment, co-insurance or deductible?), this can cause payment delays or billing errors that flow through to patient statements and create extra steps. With a single contact at your practice, the billing service can raise the issue promptly so that you can alert and/or retrain your team before the problem mushrooms.
A dedicated “partner” in the practice can also work with the biller on a regular basis to generate and review reports needed to more effectively manage the practice’s revenue cycle. The obvious examples are reports related to outstanding receivables, but you can learn a lot from other data such as your contractual adjustments (too low and your fee schedule many need adjusting), distribution of insurance plans (to evaluate your payers’ profitability to the practice) and denied claims (coding policies may need to be reviewed – along with your biller’s process for investigation and resubmission).
Establishing a routine of “meeting” (even if by phone) with your biller can not only nip problems in the bud, it will also give your biller a forum for making suggestions – for example, about new reports you might want to review, more profitable coding approaches, or even scuttlebutt about important payers.
Revenue cycle starts at the practice
Perhaps most important: your staff must not view billing as “not my job” mainly because some of the most important steps in the billing cycle are typically their job! These days, the revenue cycle starts long before a superbill is created – and, in order for your biller to maximize revenue collection for your practice, these first steps must be done consistently and correctly.
For example, staffers are often reluctant to ask patients for co-payments, past due balances and co-insurance. A “that’s the biller’s job” mentality may allow your staff to justify billing for these payments instead of collecting them. But, if staff are encouraged to view revenue management as part of everyone’s job (not just the billing service’s), they’ll be more likely to diligently collect these payments – especially once they know how much less likely the practice is to receive these balances if they’re not collected at time-of-service. This care flows through to the biller, too – better collection of up-front payments means fewer and less complicated statements, fewer customer service calls to the biller and better overall collection performance.
Laurie Morgan is a management consultant with Capko & Company. She specializes in marketing, management and technology for medical practices and blogs about practice management issues at www.capko.com/blog . Laurie has a BA in Economics from Brown University and an MBA from Stanford. She recently wrote posts for this blog on ACO Incentives Around the Bend for Medical Practices: Plan Now or Wait and See? and Medical Billing Update: Parsing the Public Comments on ACOs.
