Chandresh Shah

Billing Services failure – One simple reason

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Medical Practices outsource their billing to companies that specialize in providing such services. 

During my conversations with practices as well as billing service providers, I constantly hear about certain practices not happy with the services that they get. I also hear about billing companies complaining about how certain practices do not cooperate. In the end, it is the practice that has to bear the brunt because of inefficient billing and loss of revenue.

I know for a fact that each billing company has majority of happy and satisfied clients. Why is it then that certain practices end up not being happy with the services?

Irrespective of the software platform and vendor, let us look at the billing process. The practice selects the codes in most cases after the patient encounter. This may be a manual or an EHR based process. The billing company creates claims and submits them. If the submission is successful, the billing company follows up regarding payment and does what it has to do post payments, run reports, and manage the aging or outstanding balances.

Theoretically, all of this should run smoothly. There are certain points of communication between the billing services company and the practice. For example, there may be problems with

  • patient demographics,
  • insurance details,
  • errors in coding,
  • need for further clarity on claims by the insurance companies,
  • proof of documentation, etc.

This is usually a manual process that is established between the practice and the vendor. And, also the main stress point or cause of failure. The process may involve faxing, phone calls, or secure messaging. There should be a person assigned in the practice that understands some level of billing process so that they can effectively communicate with the vendor. It is this middle person that plays a very pivotal role in the success of outsourced billing process.

This person does not have to be an accomplished biller or an officemanager. He or she must have the basic understanding of billing process so that they can communicate with the vendor and act as a middle person to make sure there are no bottlenecks and nothing falls through the cracks. This is the most important element of success or failure within outsourced billing company.

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