In-House Billing

Personnel qualifications: It’s difficult to find good personnel who care about the performance of the billing operation as much as the physician partners. A practice rarely has the resources to hire coding experts and quality billing personnel.

Access to experts: Expertise in coding, management, insurance compensation, insurance collection and patient collection. Experts (Certified Professional Coders) stay current and keep practice informed of changing regulations and trends coming from HCFA, legislation and other insurance areas, including managed care.

Personnel turnover: Loss of personnel and then finding and training new employees jars smooth operations, and shocks the practice. Increased cost of unemployment caused by turnover, and increased dissatisfaction from patients.

No longer a concern: All billing personnel are employed by the billing company. No loss of personnel, no interviewing, no hiring the wrong people, no personality problems, no costs of turnover, no training costs.

Personnel indifference: Cavalier attitude of employees who feel that the doctors make "plenty of money" and who, therefore, do not aggressively seek all monies due the practice.

Motivated Billers whose mission and job descriptions include optimization of practice income; therefore, no shortage of receipts is considered acceptable.

Distraction from practice: Energy required by the partners to deal with the performance of the billing department, personnel turnover, and develop a comfort level with the results (income).

Focus on the Practice: Practice’s billing staff and support level are increased by the size of billing company’s staff, and billing and collections are handled without detracting from the main focus of the practice: the patients’ care.

Team distraction: Unless located away from the main part of the office, the operation is distracted and led off track from its primary mission.

Dedicated personnel: Focus on the billing operation without the distractions of the office operation, enabling optimum performance and helping to insure no data falling into "black holes."

Major Investment: Purchase expensive hardware and software to handle billing, train personnel and keep them up-to-date on the latest technology.

Access to a top computer system that provides extensive reporting for management and gives control of the practice back to the physicians.

Loss of Control: Physicians lose control of the information concerning their patients, and expend precious time trying to track down what little information is available.

Increased control for physicians through the quality management information provided by a third-party biller. Reports include, but are not limited to:
• Provider Utilization Current Year
• Composite Aging
• Insurance Aging Report by Plan
• Patient Aging Report
• Plan Procedure History by Provider
• Procedure Summary Report: Group by Plan
• Applied Payments for Current Month
• And more

Revenue shortfalls: Income is rarely maximized with an internal billing operation. Practices only realize from 50-75% of their true income generated from internal operations.

Increased Revenue: Identification and unmasking of "Silent PPO’s" and unreasonable payments from insurers (fighting "Usual and Customary" and inappropriate rebundling) through an aggressive appeal process. Practice income increases at least 5% over the costs of the billing service. The billing service is not a cost center, it is a profit center.