I am working with two physicians who are leaving a large group because they are dissatisfied with the back-office operations and billing situation. Years ago, they had their own practice and did everything in-house. Now, three years later, they want to recreate the practice of their past.
These experienced docs operated a successful private practice in another market before coming my way. After a lot of discussion, it became apparent that they are not only strong clinicians who know what support they need from their clinical staff, they also have the characteristics of good leaders who know how to motivate a small staff and engender a healthy “family business” type environment.
We’ve found them a great independent practice association to work with, one that provides good in-network rates and a slew of value-added services and vendor connections to help make it a smooth transition. In fact, there’s only one real issue.
Billing. What did you expect?
I’ve worked with a host of practices over the last 10 years. Some billed in-house. Some billed in-house but employed a certified coder to oversee things. Others used a certified coder to oversee outsourced billing. Others were cash only. And some were out-of-network, a whole other Pandora’s Box of issues.
Billing is always a hot topic with docs. I’ve met many who have felt no person or company could collect their money better than an in-house staff. I’ve met others who shied away from outsourced billing because of a bad story they heard years ago from a peer, and there are certainly some bad stories out there.
Anxiety is always present when turning over the collection of your money to people you don’t see every day. Should it be?
Unless you’re an all-cash practice or have a practice that is predominantly Medicare or Medicaid, I’ve come to feel like outsourced billing is the way to go for a number of reasons:
- Payer relationships
- Complexity of insurance plans and ACOs
- Government and hospital reporting requirements
- Claims denials
- Perspective on payer reimbursements
- Patient balances
This is, of course, a short list. In fact, each topic can generate a lot of discussion and comment. It’s almost impossible for someone not dealing with payers every day to understand how they are constantly changing reimbursements, reporting requirements, and even some rate structures. This can be especially endemic within the government plans.