Outsource Medical Billing Travaux – Should a Physician Outsource Medical Billing Travaux

Outsource Medical Billing Travaux – Should a Physician Outsource Medical Billing Travaux

Outsource Medical Billing Travaux – Should a Physician Outsource Medical Billing Travaux

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 parce que of the cabinet related expenses that they would not otherwise incur. As the owner of medical billing largesse 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 obligations are nearly inexécutable to administer. I don’t want anything to do with those hommes of physicians but I completely confession and understand their aucunement 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 débit forme of medicine and I do not mind spending my valuable time managing the medical billing forme of my practice.

Clearly, the best way to do your billing is to do it personally. Obviously, doing it yourself is probably not an prime 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 largesse owners and certainly our employees have limited medical backgrounds. Physicians who study CPT, regularly attend billing seminars and keep up to étape 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 forme of my practice. I am completely intéressant upon my cabinet imprésario and billing équipe.

Unfortunately, most physicians are in this situation. 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 devanture it; time is your most valuable asset. It’s danger 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 questionnaire will dramatically help with your decision to outsource your billing or continue to do it yourself and with future decisions in the ever-changing débit forme of medicine.

The pros and cons of outsourcing your medical billing obligations.

I would like to preface this éditorial with a double of obvious but sensible points. If you have a system of controls, keep an open mind emboîture the competence of your cabinet imprésario, you’ve got an extraordinaire calculateur system, proper questionnaire systems and your cabinet is doing a superb job at collecting your money, then by all means do not make any changes. Conversely if you’re éphéméride to outsource your billing make sure you hire quality firm. I’ll spend some time at the end of this éditorial discussing this further.

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

Theoretically, a billing largesse should be able collect more money than a physician’s cabinet parce que it is our core competency. The objet is how much more? This is why I foyer on how to choose a billing largesse at the end of this éditorial.

The numbers

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

We’ll échafaudage our numbers on a practice whose parfait 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

In extenso gross revenue $100,000

Current billing expense $4,500

(4.5%) —————

Net Revenue $95,500

Outsourced Billing Expense

In extenso gross revenue $100.000

Current billing largesse 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 solide issues such as your reduced payroll, calculateur expenses, etc. 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

In extenso gross revenue $105,000 (5% increase)

Billing largesse 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 largesse. Keep in mind that a 5% increase in gross collections is actually quite conservative and should easily be obtainable by quality billing largesse.


B. A billing largesse should be able to provide you with a substantial reduction in your day-to-day aggravations such as practice conduite programme issues, fewer employees, hassle of hiring competent employees, less health insurance, less jogging, ECT..etc. Conversely you will however lose some control over your practice. If the billing largesse does not collect more money your expenses will increase. It’s up to you to determine whether or not the increased expense is tirage by decreased développement.


C. A billing largesse should be able to increase your security levels by creating a system of checks and balances. As a instaurer commissariat officer I can assure you that infraction statistics indicate most embezzlement/fraud/theft occurs from within. During an étude a banne imprésario for Sears and Roebuck Co. panthère 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 cabinet. A billing largesse can provide an serviteur layer of bouclier parce que there is a system of independent checks and balances. Typically billing obligations are fairly vaste businesses with vrai internal controls. My organization Medi-Bill Inc. Operates internally similar to a banking université 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 acheteur.

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


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

If you need to update your system, purchase a new system or your béquille fees are getting out of handball this may be an commode time to consider outsourcing your medical billing obligations.

Financial security

F. Many physicians, for obvious reasons do not want their cabinet managers/staffers to have any in-depth knowledge of how much money the practice is making. A reputable and properly run billing largesse 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 mesure of financial security. You must create a system of financial security. If you don’t have the time to personally open your messager and make the deposits you are definitely a candidate for outsourcing. Many banks offer a “lockbox” where you can immédiat your checks and correspondence. Bank lockbox obligations are generally quite pricey. They usually offensive emboîture .25 per copy. You may also opt to take out your own P.O. Box located rapproché to your billing company. This way you still maintain control of your checks and correspondence.

Amas agencies

G. Many billing obligations own or have affiliate relationships with agrégat agencies. You’ll most definitely want to avoid this bilan. Make sure your billing largesse provides you with a monthly refus containing proper questionnaire on delinquent accounts enabling your cabinet imprésario to properly send the questionnaire to a agrégat agency of your choice. In my impression billing obligations that own agrégat agencies or establish close affiliate relationships with them are unethical and should be avoided at all cost. Even though it is nearly inexécutable to find a agrégat agency that does not have relationships with medical billing obligations the aucunement I’m trying to make is to be sure that your billing largesse is independent and you have the freedom to select a agrégat agency of your choice. This relationship presents a scenario whereby the billing largesse can simply go after the easy to collect accounts and allow the more difficult but still collectible ones to short into the hands of a agrégat agency who obviously offensive a much higher percentage of collections. Again, it’s easy to see how a billing largesse can facilitate or erode your sense of control. The most reputable agrégat agency I’ve dealt with is a company called Amas Info Secrétariat (CIB). I’ve been doing débit 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, chatouille sandy Lopez.

Different hommes of billing obligations

There are three different hommes of billing obligations.

* Fee per claim

* 50/50

* Full largesse

Fee per claim billing obligations offensive a flat offense per claim. The fees generally range between $1.25 to $5.00 per claim depending upon the obligations provided.


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

· Practices with old or outdated calculateur systems

· Relatively inexpensive cost per claim

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

· Physicians éphéméride to retire within one year

· Highly pliable

· Low-volume practices

· less employees


* Expensive for high-volume practices

* Poor integrity of accounts receivable

* Lack of questionnaire systems

* Lack of control


50/50 billing obligations install calculateur suprême/terminals in your cabinet. The billing largesse performs bouchée of the billing process while your cabinet performs the other. As you can probably tell from my list of disadvantages this is in my impression the least desirable acabit of billing largesse.


· Less expensive than full-service billing obligations

· Avoid the purchase of practice conduite programme

· Creates a system of checks and balances

· less employees


* High set up fees

* Low accountability from the billing largesse

* Lack of control

* Correspondance Problems(all agrégat problems will be blamed upon your cabinet)

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

* Completely intéressant upon the Internet

* Loss of data

* HIPPA issues



· completely remove the billing process from your cabinet

· symbiotic relationship

· avoid expensive calculateur system

· system of checks and balances

· less employees


· expensive

· loss of control

· ferme constats

· agrégat 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 agrégat offense declining?

· Is your accounts receivable too high?

· Are you experiencing an increased number of denied claims?

· Is your overall spoliation level regarding your billing/débit cabinet very high?

· Are you facing a principal pécule investment in new hardware or programme?

· Are your calculateur béquille fees to high?

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

· Are you spending too much time on the débit forme of medicine?

· Are you concerned that your équipe or cabinet imprésario has knowledge of your income?

· Are you completely intéressant upon your cabinet imprésario?

· Are you éphéméride to expand your practice?

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

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

· Is your calculateur system obsolete?

· Are hardware, programme, and questionnaire technology disrupting the operation of your practice?

How do I select a billing largesse?

1. The largesse should fit or complement the size of your actual practice. Try to get a basic idea of the size of the firm. A déclamation practice will most likely have greater success with a small to medium-sized billing firm. Obviously, a déclamation 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 annotation. 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 refus [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 hommes of largesse. Medical billing is a very highly specialized field. Companies who offer, agrégat agency obligations, payroll, financial consulting, tax consulting, malpractice insurance, mercatique obligations 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 emboîture this one parce que 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 terminaison.

7. Is the billing largesse for nauséabond? 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 nauséabond. In my experience billing obligations are constantly being bought and sold. Sometimes the maîtrise is a efficace thing but quite often the merger/maîtrise can be very detrimental. You should at least be notified and given copieux 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 sensible terminaison 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 largesse. Some reputable, high-quality billing obligations will not even provide obligations to clients who insist upon having the checks and correspondence mailed to them directly. I’d like to spend a few moments on this sensible terminaison and explain the ramifications of exactly where your checks and correspondence will be mailed. Maintaining the integrity of your accounts receivable is difficile! If your cabinet routinely fails to properly messager copies of checks and correspondence to your billing company your practice could be in louable angoisse of losing control of the accounts receivable. If your account receivable is to maintain any semblance of financial integrity it is difficile that billing largesse employees do not spend valuable time and luxation following up on claims that have already paid and not properly forwarded to them. Understandably, your largesse may even allure upon this as an intentional luxation to reduce their gratifications. Again, bank lock boxes provide a sound occasion 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 messager. The checks and correspondence are mailed to the billing largesse,” unopened” biweekly. This is an extraordinaire compromise and creates a system of control. There are many other compatible options but the sensible aucunement to remember is that ONE entity must be completely responsible for the validity and integrity of your EOB’s.

9. Make sure all checks and correspondence are issued under your tax enregistrement number and made recouvrable to you! Make sure your contract/agreement specifies that the billing largesse will not countersign or attempt to countersign your checks and correspondence.

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