Billing is a balancing act; we’ll help you determine whether to do it yourself or outsource to operate most efficiently
Your chiropractic billing and collections systems are part of the heartbeat of your practice. Interferences in these systems can be stressful and costly.
As a former in-house and outsourced biller, I am an equal proponent of both. Understandably, knowing which method of billing is best for your office requires careful consideration of multiple factors that we will address to give you a bit more solid footing and certainty as you consider your options.
In or out?
Have you found yourself teetering on the idea of outsourcing the billing for your practice? Yet, at the same time, are you feeling a bit apprehensive about handing the reins over to another person or company to manage this critical function? As you continue to ponder the prospect of outsourcing, additional uncertainties may come to your mind, such as:
- How can I find the best billing service?
- Will my billing be properly managed and get the attention it needs?
- Will outsourcing be cost-effective?
- If this is you, rest assured that you are not alone.
Or, perhaps you prefer in-house billing, but you’re struggling with establishing effective systems that can be properly maintained. For example, maybe you are finding that staff changes greatly impact your revenue cycle, because often there is only one billing department gatekeeper, or perhaps just an overall uncertainty of what’s needed to improve the health of this department. Either way, far too often, doctors are moving forward with nothing more than blind trust and hope that billing is being handled properly.
Determining your solution
The key is in determining what’s best for you and your practice, taking into consideration the necessities for an efficient and compliant billing department. As we cover these bases, consider your own practice along with the critical responsibilities of an effective billing system, including:
- A consistent insurance billing schedule
- Rejection and denial management
- A consistent follow-up schedule for calls/mail/other correspondence
- A general working understanding of code description and coding guidelines
- An ability to communicate with providers and payers on coding/billing/collections-related topics
- An ability to read an EOB/ERA (Explanation of Benefits/Electronic Remittance Advice)
- A consistent schedule for preparing and sending patient statements
- Management of aging accounts receivable
I believe that aside from keeping the “headrest paper rolling,” the single most crucial yet fundamental aspect to a practice is having sound billing and collection systems. Let’s look at what practices you need to ensure a solid billing and collections system, along with the many benefits this provides you and your practice. As we go through each of these components, carefully consider how your own practice rates in the functionality of these areas.
Areas of consideration
Time Management — No different than doctors scheduling time with their patients and allotting time for other important tasks, time management for billing and collections is essential. This includes not only a consistent frequency each week that meets your practice needs, but also the appropriate allotment of time to productively execute billing- and collection-related processes. Uninterrupted time also is extremely beneficial to increase efficiency and avoid oversights and errors.
Training — Practices often find themselves learning about code updates and guideline changes the hard way: when claims are rejected and denied for noncompliance. Health care is a world of constant change. Adequate and regular training for billing personnel provides numerous advantages to your practice, such as:
- Development of practice/patient relationships regarding billing processes
- Minimizing the risk of avoidable errors
- Improved provider-biller and practice-patient communications
- Creation of cleaner billing systems and processes
- Risk management for audits, record reviews and other investigative actions
Attention to Detail — Although coding, billing and collection systems can be learned, making sure you have the right personnel executing these responsibilities should be a priority. Missing modifiers, incomplete diagnoses and claim form fields that aren’t properly completed or updated are just a few of the oversights that lead to denials and rejections, and increase audit risk. The detail-oriented biller provides a heightened level of comfort to the practice and provider. And when the instance does arise when claims do need to be corrected or the third-party payer needs additional information, again, the training and attention to detail required by this role will likely save time and expense.
Reading EOBs/ERAs — The days of submitting a claim and just getting paid for it are well past. Simply glancing at the total amount paid and posting the amount shown is certain to cost your practice in many ways, and can even cost your patients. EOBs/ERAs are filled with information explaining one service line item after the next, including exactly what was billed, allowed by insurance, paid, required to be written off, and assigned to patient responsibility. Included with each line item are the “reason codes” that define and support the claims-processing details. Incorrect claims processing, denials that should be appealed and payment posting errors are frequently overlooked by the untrained eye.
Accounts Receivable — This area is truly a “hole in the bucket” for many practices — climbing AR due to the lack of time to manage it, or just simply the uncertainty of what to do, how to do it and even where to begin. Your practice AR is an asset, collecting money that’s due to you. The older these balances become, the more time-consuming they are to handle and the more challenging to collect. Too often, AR management is a task set to the side, receiving only touch-and-go attention and largely being left untouched for months at a time. A sound billing system, be it with an outsourced billing service or in-house, absolutely must have a systematic and organized approach to AR management.
Communication — When was the last time the provider(s) and billing personnel touched base? Are you given new information or brought up to speed on details that may pertain to certain payers or records requests where the doctor needs to provide information? Are doctors aware of what’s taking place with billing in terms of progress and challenges? Having scheduled opportunities for both the biller and the provider to share updates and ask questions helps keep your entire team on the same page and better ensures forward progress. For bodily health, the nervous system must be free of interference to allow ongoing and proper communication throughout all systems — and this concept applies similarly to your practice systems. Regular communication between billing and the doctor(s) is essential for healthy practice billing and collection systems. Practices often find that communications are sluggish and unproductive with in-house billers and more effective with outsourced services. The opposite is true for practices where communication is a team priority.
Involvement is key
Whether the practice’s billing department is in-house or outsourced, the bottom line is that providers must not turn a blind eye to their billing and collections department. Assuming it’s all being handled and done properly is not an effective or safe strategy. Regardless of your decision to outsource billing or manage it in-house, you have these tools at your disposal to make the best decisions for your practice and help your team as a whole.
Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA, has served chiropractic since 1999. She holds multiple certifications in the areas of coding, compliance and auditing. She has a passion for serving practices by helping them obtain information, understand rules and regulations and streamline their practice systems. A Virtual Chiropractic Assistant with CHelpDesk Solutions, she can be reached at chelpdesk.com.