Four Signs Your Practice May Need to Move Medical Billing Outside

Do you tear your hair out daily dealing with CPT and DX codes? Are you exhausted from following up on time-consuming rejections or denials?

A high-volume dermatology practice in Eastern, CT, and client since 2005, could have answered “yes” to these questions. But the a-ha moment came when they realized a billing service could help them keep up with demand and billing, plus track appointments and cancelations.

If they weren’t using a billing partner, their practice manager said they would need to hire two additional full-time employees just to handle insurance billing.

Rather than hire someone to work night and day on billing to keep your practice running smoothly, it may be time to look outside your four walls for a business partner.

Not convinced? Here are four signs your practice may need to move billing and collections outside.

1) You’ve put your trust in one individual.
If your practice has consolidated all financial management under the stewardship of a single individual, be cautious as this puts your practice at risk for embezzlement. According to a 2009 MGMA study, 83% of practices surveyed had been the victims of employee theft or embezzlement.

2) A single person is responsible for filing all claims.
The complexity and requirements to file a successful claim are outpacing even the most motivated office manager. Relying on a single person within a practice to navigate all of the electronic field requirements – and to keep track of which carrier requires which fields – may be costing your practice time and money.

3) You don’t have someone on-staff to track and follow up on each claim filed with each carrier.
Many practice staff develop the bad habit of submit-and-forget. If the claim gets lost by the carrier or the carrier requests more information before they pay, the claim may get overlooked and age out as unpaid. Who on your team is going to have the time and attention to devote to tracking each claim filed with each carrier? Do your current systems have the necessary capabilities to do this?

4) You have a trusted family member or student managing your billing.
The business of revenue management has become as or more complex than tax filing. How many practices try to handle their own taxes? So why struggle with claims management and carrier follow up? Consider this – taxes happen once every three months. Billing happens daily, or at least should be happening daily, and the volume is considerably greater. The odds are increasingly stacked against the practice that expects to manage this process by hiring a trusted family member or student fresh out of a six-month billing school.

Billing has gone professional. The skill and investment necessary to stay current and competent has become more like hiring a CPA or selecting experienced legal counsel. After all, this is a business decision that will determine your practice’s profitability and financial stability.
If you are still struggling to manage this function internally, consider the time and money (not to mention hair) you may be losing. Maybe now is a good time to evaluate how a billing partner could impact your practice operations and revenue collections?

About the Author

Jennifer Dudek, Director of Operations, Claim Resolution Service Center
ADP AdvancedMD | Medical Billing Services
Jennifer has more than 20 years experience in all aspects of revenue cycle management, having started and run a billing services business based in New York, then later moving into various support and management roles where she worked with medical practices and large healthcare organizations. Jennifer joined ADP AdvancedMD in 2010 as a Relationship Manager on the Billing Services team, later moving into a Sales Executive role. She now functions as Director of Operations, Claim Resolution Service Center, for the Medical Billing Services unit of ADP AdvancedMD.

Prior to AdvancedMD, Jennifer was Director of Implementation for New Jersey-based The MedWin Group, which helped large MSOs and IPAs pursue healthcare related grants for developing workflows to support revenue cycle management and EHR implementation.

Jennifer has a Bachelor of Economics degree, with a concentration in Healthcare, from Purchase College-SUNY and a Master of Education degree from Cambridge University.