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There are many reasons healthcare practices might outsource their billing to a professional medical billing service; confusing insurance requirements, staffing problems and just keeping up with industry changes are a few examples. In the end though, the reasons most medical billing companies hear about come down to the two driving principles of any business – Time and Money. This article discusses how medical billing services are able to create significant savings in time and money for healthcare providers.

Medical Billing Services Save Training and Research Time - Some readers might take the short view and think medical billing companies just enter data into a computer and send it off to a clearinghouse. In reality medical billing is a detailed process requiring specialized skills and in-depth knowledge of medical practice management, insurance industry practices, and the regulatory framework around state and federal laws. Professional medical billing companies invest countless hours in training and research to keep abreast of current codes, submission requirements, industry trends and the needs of their clients.

Significant expenditures are also made to ensure medical billing companies are up to date on the latest software. In a constantly changing industry, software vendors are always finding new and better ways of supporting practice needs. It’s not practicable for small or medium sized practices to dedicate the time necessary to stay on top of the latest innovations.

These investments of time by professional medical billing services are often not considered by providers, but they eliminate endless hours otherwise spent in seminars, meetings with vendors, or on the phone with clearinghouses and carriers. This time savings creates a valuable commodity for a practice seeking the edge necessary to keep up with a rigorous patient schedule.

Medical Billing Services Save Operational Time -Medical billing services are able to save operational time by leveraging the economy of scale and the efficiency of task specialization.

Professional medical billing companies, by their very nature, create an economy of scale in maintaining a team of medical billing professionals to provide services across several practices. This structure creates a well trained pool of resources to manage each practice’s needs rather than just one individual overseeing all billing functions. The team approach also removes interruptions to revenue flow that result from vacations, unexpected sick time and staff turnover.

Task specialization among teams further heightens the efficiency of medical billing companies. Through task specialization, a team of billers can accentuates individual skills and reduces distractions of other activities.

Consider a provider who sees an average of 30 patients per day, or a total of 150 encounters per week. The time required to generate and submit 150 patient claims and follow up with insurance carriers with a high lever of accuracy can take up most of the time of an in-house biller. But this is just the beginning. That same individual will also need to follow up on denied or partially paid claims, researching why and resubmitting for further review. Patient invoices require additional time- printing, stuffing and mailing- as well as posting payments, running reports and providing detailed analysis on the current state of the practice; all this just to meet the standard offering of professional medical billing companies.

Through task specialization, medical billing companies might offer each of its clients several billers submitting claims and reviewing insurance payments with the highest level of accuracy. At the same time, the service might have other individuals or groups dedicated to managing patient invoices and questions across several practices with increased efficiency. This approach maximizes the time available for each activity by specialists with a greater knowledge of their roles, and, again, guarantees minimal (if any) interruption during employee leave and staff changes.

Medical Billing Services Save Money -Hiring and training new staff, employee benefits, vacation/sick leave, and staff turnover are just a few factors increasing the costs of managing an efficient in-house billing program. Added to the operational overhead of day to day billing, software/hardware maintenance, clearinghouse fees, postage, and so on, the list of expenditures for practices is endless.

Good medical billing companies will design their services around covering all of these costs and immediately do away with the problems they create. To clearly demonstrate how medical billing services can save practices money, let’s compare the core costs associated with in-house medical billing against working with a professional medical billing service.

Cost of In-House Billing: Our comparison begins with a typical practice with one or two providers. Let’s assume this practice has a dedicated, in-house biller receiving an annual salary of $30,000, or about $14.50 per hour. The chart below outlines the additional costs of having a full time employee in the office to handle all aspects of medical billing.

• Base Pay --------------------------$30,000
• Medicare and Social Security ---------$2295
• 401K --------------------------------$1080
• Disability -----------------------------$720
• Healthcare --------------------------$5220
• Time off -----------------------------$3270
• Total labor for 1 in-house biller ------$42,585

Next, we’ll need to consider materials and fees. An average practice will probably upgrade computers and software every 3 years at a cost of about $6,000. Spread out over those three years, we’ll assume an average annual software/hardware expenditure of $2000. Since our practice will send out its own patient statements, we’ll need about $150 per month for postage, paper and envelopes, an annual cost of $1800. Clearinghouse fees for electronic claims will come to about $60 a month, or around $720 annually. For the sake of simplicity, we’ll forget for the moment that our biller will need a climate controlled workspace, lights, general office supplies and a desk.

Here’s what our list of software/hardware, materials and fees looks like:

• Software/Hardware -----------------$2000
• Materials ---------------------------$1800
• Clearinghouse Fees ------------------$720
• Total ------------------------------$4520

Adding the two totals above (labor + materials & fees), the annual cost of medical billing services performed in-house by the practice comes to $47,105 per year. Of course this number might not mean much until we put it in perspective against teaming with a professional medical billing service. As we move forward, keep in mind this conservative estimate does not factor in those other costs mentioned above that are often hidden - ongoing training, unexpected leave and sudden staff changes.

Cost of Professional Medical Billing Services: To evaluate the cost of working with medical billing services, we’ll assume our practice has contracted with a medical billing company for full service billing. This includes all of those activities that would otherwise have been performed by the in-house staff above; claim generation/submission, insurance follow up, patient invoicing and support, detailed reporting, expert practice analysis, etc. We’ll also assume the practice has negotiated a rate of 8% of collections with its professional medical billing service.

Note: Calculating costs for medical billing services will vary slightly depending on the fee structure but will usually be based on either a percentage of collections or a fixed fee per claim. For more information on fee structures, see Percentage vs. Flat Fee Pricing by Medical Billing Services.

Assuming our provider visits 30 patients per day, 50 weeks out of the year, we’ll have 7500 patient encounters per year. If each encounter results in an average reimbursement of $60, our receivables come to a little over $450,000 per year. At a rate of 8%, the annual cost for the professional service to manage all aspects of medical billing services for the practice would be $31,500. In comparison with in-house services that’s a savings of $15,600 per year!

This is a very difficult decision for any physician and partially boils down to this or her own personal ideology and comfort level.

Hospital-based physicians will almost always be better off outsourcing because of the office related expenses that they would not otherwise incur. As the owner of medical billing service you may think I'm naturally biased towards outsourcing. I can assure you that this is not the case.

Physicians who are overly controlling, uncomfortable or mis-trusting toward billing services are nearly impossible to administer. I don't want anything to do with those types of physicians but I completely respect and understand their point of view. Setting all ideology aside I would like to delve into the pros and cons of this difficult and complicated decision.

I am a physician who is very interested in the business aspect of medicine and I do not mind spending my valuable time managing the medical billing aspect of my practice.

Clearly, the best way to do your billing is to do it personally. Obviously, doing it yourself is probably not an option but if you're willing to spend the time and have the interest I would recommend that you do your own billing. Keep in mind that most billing service owners and certainly our employees have limited medical backgrounds. Physicians who study CPT, regularly attend billing seminars and keep up to date on industry changes are the ultimate medical billing gurus in my view.

I am a physician who has absolutely no time or interest in the medical billing aspect of my practice. I am completely reliant upon my office manager and billing staff.

Unfortunately, most physicians are in this position. Even if they were interested in keeping up with all the changes and elements of medical billing the practical reality is that there is absolutely no time. Let's face it; time is your most valuable asset. It's sort of like mowing your own lawn. You'd be way better off financially seeing patients for three hours on Saturday morning. I believe the following information will dramatically help with your decision to outsource your billing or continue to do it yourself and with future decisions in the ever-changing business aspect of medicine.

The pros and cons of outsourcing your medical billing services.

I would like to preface this article with a couple of obvious but important points. If you have a system of controls, keep an open mind about the competence of your office manager, you've got an excellent computer system, proper information systems and your office is doing a superb job at collecting your money, then by all means do not make any changes. Conversely if you're planning to outsource your billing make sure you hire quality firm. I'll spend some time at the end of this article discussing this further.

Most leading experts agree that it costs about 4.5% of net collections to perform the billing function within a physician's office. Incidentally, this is close to my actual cost as well.

Theoretically, a billing service should be able collect more money than a physician's office because it is our core competency. The question is how much more? This is why I focus on how to choose a billing service at the end of this article.

The numbers

A. Lets just do the math in a theoretical model.

We'll base our numbers on a practice whose total gross receivables are $100,000 per month. Obviously, this is an overly simplistic model designed to quantify the aggregate cost and or opportunity cost of the medical billing component only.

Current Aggregate Billing Expenses

In-house expense

Total gross revenue $100,000

Current billing expense $4,500

(4.5%) ---------------

Net Revenue $95,500

Outsourced Billing Expense

Total gross revenue $100.000

Current billing service exp. $7,000

(7.0% net collections) ---------------

Net Revenue $93,000

Net cost increase with outsourcing = $2,500.00

As you can see in this,” all things being equal” theoretical model your practice would incur a $2,500 decrease in net revenue with the implementation of a billing outsource strategy. Keep in mind that this model does not address other less tangible issues such as your reduced payroll, computer expenses, ect. In reality the net cost could be substantially less than $2,500. Many physicians will perceive this as a small price to pay while others will consider it to be cost prohibitive.

5% theoretical increase in gross revenue with outsourced billing

Total gross revenue $105,000 (5% increase)

Billing service expense $7,350

(7% net collections) ----------------

Net revenue $97,650

$95,500 - $97,650 = $2,150.00 increase in net revenue.

As you can see from this model with a 5% increase in collections your net revenue will increase $2,150.00 with the added expense of the billing service. Keep in mind that a 5% increase in gross collections is actually quite conservative and should easily be obtainable by quality billing service.

Intangibles

B. A billing service should be able to provide you with a substantial reduction in your day-to-day aggravations such as practice management software issues, fewer employees, hassle of hiring competent employees, less health insurance, less training, ECT..ect. Conversely you will however lose some control over your practice. If the billing service does not collect more money your expenses will increase. It's up to you to determine whether or not the increased expense is offset by decreased aggravation.

security

C. A billing service should be able to increase your security levels by creating a system of checks and balances. As a former police officer I can assure you that crime statistics indicate most embezzlement/fraud/theft occurs from within. During an investigation a store manager for Sears and Roebuck Co. once told me," our customers take it out piecemeal but our employees take it out in wheel barrels" This logic also applies to a doctor's office. A billing service can provide an extra layer of protection because there is a system of independent checks and balances. Typically billing services are fairly large businesses with strict internal controls. My organization Medi-Bill Inc. Operates internally similar to a banking institution with the way we handle funds. It is highly unlikely that the ownership of a reputable medical billing firm would risk the consequences of committing fraud against a client.

Conversely, the issue once again boils down to control. Many physicians are understandably quite unsettled at having their checks and correspondence mailed directly to the billing service. Further compounding this dilemma is," what will happen to the checks and correspondence after the billing service agreement is terminated?”(Again, we will discuss alternatives to this at the end of the article)

Technology

D. State-of-the-art practice management software is an extremely expensive investment. If you've already invested in a high quality computer system I do not believe outsourcing your billing would make much sense financially unless your computer vendor is charging outrageous support fees. If you're considering purchasing a computer system or a medical record management system my favorite vendor who we've been working with for over 15 years is Office Management Solutions (OMS) based in Tampa Florida. The owner's name is John Peake and he is by far the most honest and reputable computer vendor I have ever worked with. OMS can be reached at 813-963-5582 or www.oms-online.com.

If you need to update your system, purchase a new system or your support fees are getting out of hand this may be an opportune time to consider outsourcing your medical billing services.

Financial security

F. Many physicians, for obvious reasons do not want their office managers/staffers to have any in-depth knowledge of how much money the practice is making. A reputable and properly run billing service can create this level of financial security. The best case scenario is for your staffers to only see your expenses and have only a limited understanding of the revenue being generated. This can also be accomplished internally by making and recording your own deposits. If you're going to do your own billing I must emphasize the importance of financial security. You must create a system of financial security. If you don't have the time to personally open your mail and make the deposits you are definitely a candidate for outsourcing. Many banks offer a "lockbox" where you can direct your checks and correspondence. Bank lockbox services are generally quite pricey. They usually charge about .25 per copy. You may also opt to take out your own P.O. Box located adjacent to your billing company. This way you still maintain control of your checks and correspondence.

Collection agencies

G. Many billing services own or have affiliate relationships with collection agencies. You'll most definitely want to avoid this situation. Make sure your billing service provides you with a monthly report containing proper information on delinquent accounts enabling your office manager to properly send the information to a collection agency of your choice. In my opinion billing services that own collection agencies or establish close affiliate relationships with them are unethical and should be avoided at all cost. Even though it is nearly impossible to find a collection agency that does not have relationships with medical billing services the point I'm trying to make is to be sure that your billing service is independent and you have the freedom to select a collection agency of your choice. This relationship presents a scenario whereby the billing service can simply go after the easy to collect accounts and allow the more difficult but still collectible ones to slip into the hands of a collection agency who obviously charge a much higher percentage of collections. Again, it's easy to see how a billing service can facilitate or erode your sense of control. The most reputable collection agency I've dealt with is a company called Collection Information Bureau (CIB). I've been doing business with them for years and they have never attempted to establish an affiliate relationship with my company. CIB can be reached at 1-800-231-3514, contact sandy Lopez.

Different types of billing services

There are three different types of billing services.

* Fee per claim

* 50/50

* Full service

Fee per claim billing services charge a flat rate per claim. The fees generally range between $1.25 to $5.00 per claim depending upon the services provided.

Advantages:

· May be helpful to a brand-new practice who is not fully implemented a computer system or is still trying to decide whether to outsource.

· Practices with old or outdated computer systems

· Relatively inexpensive cost per claim

· Excellent for practices who have a problem with only one particular payer group such as Medicare or payers that require electronic claims submission

· Physicians planning to retire within one year

· Highly flexible

· Low-volume practices

· less employees

Disadvantages:

* Expensive for high-volume practices

* Poor integrity of accounts receivable

* Lack of information systems

* Lack of control

50/50

50/50 billing services install computer terminal/terminals in your office. The billing service performs part of the billing process while your office performs the other. As you can probably tell from my list of disadvantages this is in my opinion the least desirable type of billing service.

Advantages:

· Less expensive than full-service billing services

· Avoid the purchase of practice management software

· Creates a system of checks and balances

· less employees

Disadvantages:

* High set up fees

* Low accountability from the billing service

* Lack of control

* Communication Problems(all collection problems will be blamed upon your office)

* Your staff will still probably wind up doing most of the work

* Completely reliant upon the Internet

* Loss of data

* HIPPA issues

Full-service

Advantages:

· completely remove the billing process from your office

· symbiotic relationship

· avoid expensive computer system

· system of checks and balances

· less employees

Disadvantages:

· expensive

· loss of control

· patient relations

· collection agency relationships

Should I outsource my billing checklist: If you answer yes to most of the following questions then you should probably consider outsourcing?

· Is your overall collection rate declining?

· Is your accounts receivable too high?

· Are you experiencing an increased number of denied claims?

· Is your overall frustration level regarding your billing/business office very high?

· Are you facing a major capital investment in new hardware or software?

· Are your computer support fees to high?

· Are you having a difficult time keeping or hiring experienced billing staff?

· Are you spending too much time on the business aspect of medicine?

· Are you concerned that your staff or office manager has knowledge of your income?

· Are you completely reliant upon your office manager?

· Are you planning to expand your practice?

· Do you believe that your practices cost structure is too high?

· Do you have several employees performing tasks that could be handled by a single more experienced manager?

· Is your computer system obsolete?

· Are hardware, software, and information technology disrupting the operation of your practice?

How do I select a billing service?

1. The service should fit or complement the size of your actual practice. Try to get a basic idea of the size of the firm. A solo practice will most likely have greater success with a small to medium-sized billing firm. Obviously, a solo family practitioner would probably not be very well served by a publicly traded firm.

2. Avoid long-term binding contracts. You should be free to terminate your agreement any time within 30 days written notice. The agreement should clearly specify what each side will do for the other. Make sure the agreement assures that upon termination you'll receive a highly detailed account receivable report [listed by individual patient] .

3. Ask for references and call the other providers!

4. Inquire/investigate the actual owner of the company. Ask to speak with the owner directly.

5. Avoid firms who offer too many different types of service. Medical billing is a very highly specialized field. Companies who offer, collection agency services, payroll, financial consulting, tax consulting, malpractice insurance, marketing services etc. etc. are not in my view focused enough on what they're there to do. Collect your money!

6. Ask other physicians. Keep open mind about this one because physicians who are happy with their billing company do not necessarily want them to grow and generally like to keep a low profile on this issue.

7. Is the billing service for sale? Try to ascertain whether or not the firm has recently been sold. In your contract/agreement you should request to be notified within 30 days of the pending sale. In my experience billing services are constantly being bought and sold. Sometimes the acquisition is a positive thing but quite often the merger/acquisition can be very detrimental. You should at least be notified and given ample time to make a proper decision on whether you'll stay with the new firm or select another.

8. Where will your checks and correspondence be mailed? This delicate and important issue need not be as complicated as it appears. Many physicians for obvious reasons are reluctant to allow checks and correspondence to be forwarded directly to their billing service. Some reputable, high-quality billing services will not even provide services to clients who insist upon having the checks and correspondence mailed to them directly. I'd like to spend a few moments on this important issue and explain the ramifications of exactly where your checks and correspondence will be mailed. Maintaining the integrity of your accounts receivable is crucial! If your office routinely fails to properly mail copies of checks and correspondence to your billing company your practice could be in grave danger of losing control of the accounts receivable. If your account receivable is to maintain any semblance of financial integrity it is crucial that billing service employees do not spend valuable time and effort following up on claims that have already paid and not properly forwarded to them. Understandably, your service may even look upon this as an intentional effort to reduce their commissions. Again, bank lock boxes provide a sound alternative to this dilemma. Some practices solve this problem by directing all checks and correspondence to a P.O. Box keeping EOB’s separate from other corporate mail. The checks and correspondence are mailed to the billing service,” unopened” biweekly. This is an excellent compromise and creates a system of control. There are many other possible options but the important point to remember is that ONE entity must be completely responsible for the validity and integrity of your EOB’s.