Billing is arguably the most complicated facet of running a practice. The process starts the moment a patient signs in at your office, and it doesn’t end until an insurer pays the bill (hopefully). And everyone in your practice is involved, meaning there are numerous places where things can go wrong. A front-desk staffer could fail to verify insurance. A doctor could log an improper code. A billing clerk could submit an incomplete claim. And so on.
If anyone stumbles during the process, your accounts receivable can morph into a monster capable of destroying your practice. You can hide under the blankets and hope the monster will go away, but it won’t.
Fortunately, there are tools available to help you vanquish the beast and take control of your A/R. By doing so, you’ll end up with more money in the bank, a happier staff, and better patient care. Let’s take a look at what’s out there.
A little help from a friend
Brenda Cottrell, billing manager for Southeast New Mexico Oncology & Hematology, remembers how bad the practice’s billing problems once were: More than $6 million in A/R and scads of rejected claims, with a distressing number of them facing timely denial. “We were doing all our own billing electronically ourselves. It just became overwhelming,” says Cottrell. “We would get denials, and we didn’t have time to work on them.”
That was two years ago. Today, the practice’s A/R is down by about 40 percent. Most payments post within 45 days. The denials have been reworked and resubmitted. What’s more, the staff feels much more relaxed. They have time to spend on issues beyond billing, such as securing copay assistance for patients and applying for compassionate drugs, (prescription drugs supplied to low-income or uninsured adults who need them for chronic care).
How did the practice achieve this? By outsourcing its billing needs to a billing services company.
Cottrell cites peace of mind as a major benefit of using Catalisse, the billing company it chose. By outsourcing, the practice’s billing staff can now concentrate on less routine matters. Before, they’d all but given up on having time to work their denials, many of which had timed out — a permanent loss of income. “We’ve almost completely eliminated that,” she says.
How does a billing service fit into a practice’s inner workings? “We copy EOBs received and Catalisse posts them. Then they enter our charges. They do the coding, making sure all charges are entered correctly,” says Cottrell. “We work the noncontracted insurances and Medicaid; they do everything else. We send them our denials.”
Denials are way down in number now, because Catalisse thoroughly scrubs the practice’s claims so they’re more likely to go through the first time. And payments fill the coffers much faster than before. “It used to be 65 to 80 days to get a payment; now it’s about 45,” Cottrell says.
A billing service can also help pinpoint data gaps or procedural anomalies that might otherwise go unnoticed. Southeast New Mexico’s staff sometimes forgot to capture required authorization numbers for claims forms, thereby fattening the denials stack. Catalisse created a report to flag patients needing such authorization numbers.
A good billing service will treat communication as a top priority. Cottrell says she communicates with her Catalisse contact every morning to discuss any relevant issues. Staying in touch keeps the arrangement well oiled.
If a problem does arise at the practice, a billing service has your back. On one occasion, the practice was having a problem with formatting the form for electronic billing. “I worked on the forms, and they did the hardcopies so we wouldn’t fall behind. It’s a team effort.”
But a close, efficient relationship doesn’t suddenly appear on Day One. It takes times to acclimatize the company to the way your practice conducts business. Cottrell says that the two were in near-constant communication for the first six months.
You’ll probably have to change at least some of your own ways too. You’ll need to blaze new procedure trails and expect the workload to increase temporarily, much as when you clean out your garage — worse, and then much, much better. Persevere, and in the end, you’ll have a reliable ally for your practice’s claims submission.
