Home Forums Discussions Coding and Billing Billing Coding inhouse - Pros and Cons

Pros and Cons of in house billing? As I've been at my wife clinic more last couple weeks, I could see that for family doc CPT codes 80% same, if the ins verification done good then claim denials quite low.

My doc doesn't trust me in handle billing as I am somewhat not caring much about money, born rich mindset. But even for my older brain, couple mistakes here and there could still be less than 3, 4 K monthly billing charge. Not like old days, to run a solo is hard now a day to make profit, a% percent billing, b% accounting, c% utilities... all added up

One of our friends been working for a salary for quite sometimes, and got tired of politics so he just opened his own and doing billing himself later at night. He told me it is not that bad and for a his new start up that would save money ( monthly fee is only 100-200 a month, unlimited claims).

Walter -- thanks for the post! I'm struggling with the same topic. We have an outside biller that gets 8% of the collections for the billing (not copays or cash paying patients on the day of service). I've submitted a few 10-15 "clean claims" with Office Ally and that worked fine and quick turnaround on payments (10-15 days). My concern though is having to do double entry since it is not an all in one product. You'd have to use some form of practice management software to manage payment on claims, what is pending, etc. to avoid missing out on payments. Office Ally is free for most of the services, so one huge benefit.

I haven't used EZ Claims before but that looks promising with the direct interface with Amazing Charts. I've seen some information on Kareo and wondering if anyone has any experience with this product for practice management and billing. I'd love to see what Amazing Charts has coming with their Practice Management program to see if this will provide an all in one option to bill, manage/keep track of payments, etc.

John, our billing company uses Kareo and setup website access for our staff including myself. Probably all billing software would be same just need time to be efficient.

We pay 6% so your 8% is too much. I think billing price structure based upon old paper claims, too much hassle then but since claim moving into web base programs, all claims verified before sending to ins companies,chances for mistakes should not be that high. We have our trusty staff in their spare time to input payments info into AC accounting, so missing claim easy to spot.

Kareo tracts claim and let users know if claim has been approved or rejected. My concerns is all billing data and insurance/medicare payment info is with the billing company, how to transfer all that back into our control smoothly.

Per my experience with most things in life, any change is ready for transition headache. Anyone know how to do with this transition process, to fire a billing company and take billing in please give your 20 to a dollar sense. Seems we got into a messy addiction started out by outsourcing.

Notice of Full Disclosure: I am IT and software development for a billing center.

Let's be clear about something: Hiring a billing center to do your billing is nothing short of outsourcing. And outsourcing is about one thing: money.

The question is does your current billing center save you money?

1. How much are you paying your employees now?

2. How much does a billing center charge?

3. What are your current collection rates through the patient statement?

For example, let's say your are a single provider podiatry clinic and you have four people working on your staff. You have the office manager, the front desk clerk, the assistant, and the biller. The biller probably costs you at least $20,000 per year in salary alone. Plus, you have the billing software you have to pay for. A billing center that collects 94% of all money billed out for you through the patient statement and charges you 8% is going to beat having your billing in-house hand-over-fist no questions asked.

The question then, is finding a billing center that is that good.

Other things to consider:

1. Does your billing center offer a termination clause whereby either one of you can terminate the relationship with a three day written notice?

2. Does your billing center guarantee that you will get your data in an easy format, such as CSV, should the relationship terminate for free?

3. Does the billing center provide monthly reports along with their invoice to show you where things are and how things are going?

4. Does the billing center provide you with access to your data?

All things to consider.

JamesNT

James, yes that what we had thought about when we started our billing outsource. I excused myself from billing involvement at the time. Our billing service company is small and local . We did not pay much attention to all point 1,2,3,4 you mentioned then.

My point is not how expensive the service if you hire a full time billing staff, billing service is more cost effective no doubt about that also no worry about staff turn over, take away most billing headaches. But if solo doc started out with heavy debt or has spousal support (who working for free or in exchange of romantic candle light dinners, not talking about expensive vacations many times a year here) then doc can save 6-8 percent in billing code. For our practical situation, client base almost same due to doc work/life balance issue, all expenses are up.. to the point, gross income is much higher than national average, but net income is much lower. We are not that efficient compared to larger practices.

One example, most ins try to squeeze dry smaller docs. As family PCP we have to stock expensive preventive/treatment injections, but they only pay couple dollars higher then purchased prices, hundred dollar shots are norm. One bottle might be for five shots, but if staff makes mistake then only 3, 4 shots available, wow, we might want to save money on 0ne dollar paper tissues but lost tons of money in med. Drug companies bill us thousand of dollars every month.

Open a can of worms here, any inputs on how to deal with this issue? I am thinking of create an inventory system on med inventory to control ins and outs, like a fancy loss prevention term, but my doc said that might create another burden on staff, but that should be done.

So back to billing question, now you could tell that we don't make enough money and want to take the billing back, temporary at least, until we feel comfortable enough or make same salary like doc working for someone else. Then 5-7% increases in profit. My friend said he doing his billing now later at night but he is still able to manage it without his spousal support. He also said many older docs in area still doing paper submitting themselves, he lives in a smaller town.

As you are an insider, how to re channel all ins info back to us smoothly and only give billing company tree days notice. Like job security everywhere, a fire not that simple, it might back fire.

I'd be interested in how many doctors do their own coding/billing submissions. For internal medicine, we don't have a ton of codes to worry about -- so 95%+ are fairly straightforward. I just have a hard time signing those checks for the billing company when they are coding what I tell them to already. They are good at following up though on unpaid claims -- so is it worth the 8% for this or are you better of doing it on your own or with the help of the office staff on following up on these claims. Just curious to what other doctors are doing.

Quote from DrGrauman:

'

Over the years, we have tried outsourcing the billing a couple of times. Both attempts were disasters, and James touches on some of the reasons.

First and foremost, all of your billing data... that is, effectively, all of the money you have earned that is not in your bank... can now effectively be held hostage. If you decide that the arrangement is not working and wish to fire your billing service, you have to assume that you will not be on the best terms. Sure, maybe there is an agreement to get a CSV file, etc. but the billing service will at this point have absolutely no incentive to do so quickly or have any interest in resolving issues. ("Here is your CSV file; oh, what do you mean, what do the numbers in each of those 35 columns represent? We said we'd give you the data, and there it is. We consider the description of those fields to be a proprietary part of our source code. We did not say we would translate it for you or assist in putting it into your new program/service. That's your problem.") In a couple of cases, the service suddenly decided to impose huge fees to get our data back. Importing your billing data into a new system is never as smooth as it is supposed to be, and there is always corrupt data. Having been through this maybe 5 times over the years, the only way that works is to keep the old system alive on a computer in the corner someplace and just start fresh, and re-register everyone in the new system. If you don't have access to the old system, then you are left with a mess, or perhaps a foot high stack of printouts.

Yes, it looks a lot cheaper on paper to outsource. But it is necessary to look at this a lot like getting married. You have just handed access to your entire life savings to this sweet young thing, and it is amazing how expensive it becomes when the time comes for a divorce, and how ugly your relationship suddenly becomes. Keeping it in-house is cheap insurance.
_________________________
David Grauman MD
Internal Medicine and Aviation Medicine
Fairbanks, Alaska

'

end quote

John:

We outsource billing at 7%. Ithink I do this for the convenience. Yet, I know they don't care about my money as much as I do. I don't have the right staff to help with bringing it back in house....and I'm getting a little lazy about wanting to take on another job.

I find the main advantage is staffing reliability.
I am in solo practice. I could get by with a receptionist and MA and have the billing outsourced. But I prefer to have 3 staff members, reception,billing and MA. When someone is ill or goes on vacation I can get by with just 2 people. This would not be the case if I only had 2 employees. I would need to find temps for coverage.
The other issue is SoCal is the paperwork for insurance referrals, the outside billers don't handle this.
The fact that I have full control of the process is just an extra advantage. I have been lucky and have only had 3 different people doing the billing in my 28 years of practice.

Greg

Internal Medicine/Solo practice in So. Ca. x 20 years. In house billing always. Reliable staff of 3 (Receptionist, MA and Biller). All are trained to input charges into practice mgmt software. Biller double checks claims before they are sent out electronically with the click of a button. Clearinghouse ($100/mo) "scrubs" the claims, spits back what needs fixing, then off to the insurance companies. There is even an option to receive EOB's electronically, which we have not tried yet, still get them via USPS. Can also send secondaries elect. Biller examines EOB's to make sure everything alright, if not, fix and send back. Can not imagine giving up control and 6% or greater of gross income, especially in this economy. Looking forward to A/C's practice management program, after they get the kinks out, of course. Good luck!

John, We have been using EZClaim for a year. It is working fine. The only problems
1. AC export data missing modifier and unit number. every claim we have to check AC to correct in EZClaim if the number is great than 1. because EZClaim put 1 as default.
2. There are 2 systems to store the account data both AC and EZClaim. It is hard to maintain sync.

I'm paying 6% and I think it is the best money spent. I don't need an extra office room for a biller, I don't have to pay taxes on them and deal with employee issues, and the billing company handles collections, angry phone calls, and all such hassle. This lets me focus on medicine. If someone is staying up late at night to save a few hundred dollars, it is not time or money well-spent for a physician.