Years ago, billing was easier.  Billing was done to fill in time between scheduling patients and pulling charts.  Payers changed the regulations only once a year and denials averaged only a few percent.  In-house billing operations are faced with inherent collection problems, compliance issues, and time delays.

There are some inherent problems with in-house billing.  If you want to achieve maximum reimbursement from payers, you need to make sure your biller is working effectively in the following areas:

• Follow-up on unpaid claims. Even though follow-ups are burdensome and time consuming (and it’s usually the last thing anyone in the office wants to do), it’s a “necessary evil.”  Plus, not following up on unpaid claims can lead to complications with “timely filing” requirements.

• Don’t apply incorrect discounts and write-offs. Unfortunately, discounts are often applied to patients even when the physician doesn’t participate with that payer, costing the practice thousands of dollars a year.
• Take advantage of continuing education opportunities.  Although continuing education is expensive, regulations change constantly, and without it, your biller will not know the current highest allowable reimbursements, or deleted or modified codes.
• Develop and maintain an effective compliance plan.  (More about this in another blog post—stay tuned!)
• Invest in technology and training.  This is a huge cost for any private practice, but managing IT to make your billing more efficient is worth the investment. 
• Tie your biller’s wage to collections.  Most in-house billers are paid hourly, so they do not have any incentive to collect all allowable reimbursements.
• Make regular audits of fee schedules from your payers.  Again, this is necessary to make sure you’re collecting all you’re entitled to.
• Audit those same fee schedules to update or delete procedure codes.  Billing for outdated codes practically guarantees you won’t be paid.

It’s difficult to evaluate an in-house billing operation.  These are just a few of the practices of a good medical biller. Unless you have billing expertise, you simply cannot tell how much money is lost due to improper coding, misuse of modifiers (causing denials and incorrect payments) and lack of effective follow-up.  It’s a good idea to have an independent agency analyze your reimbursements to make sure you’re collecting at an optimal rate.  The national average for collections is 92%, even the AMA says that an average in-house billing operation will leave 10-15% uncollected.  This may be a hard pill to swallow, but it’s necessary to know the true status of your in-house billing department if you are to ensure you’re collecting all the revenue to which you’re entitled.

Every practice needs to make an informed decision whether or not it’s cost effective to maintain an in-house billing operation.  Today’s billing takes a highly specialized set of skills and resources to be successful.  It’s difficult to attract and retain a competent biller.  Because medical billing is an ever changing complex field of codes, modifiers, rules and regulations, billing has become a specialty unto itself.  Billing companies offer economies of scale, making their services less costly to each practice.  I was always taught never do something that others can do better, faster and cheaper than you can.  If your billing department avails itself of all the tools and tricks available, you’re probably okay, but my advice is to focus on helping patients and outsource the billing.

Barry Shatzman is a Certified Healthcare Billing & Management Executive and Chief Operating Officer of Medical Billing Resources, Inc., in Farmington Hills, Michigan.  Please feel free to comment on this post or to contact him directly at barry@medicalbillingresources-mi.com, or at 248-932-2607.