The Future of Medical Billing for Pediatric Practices

March 7, 2011 in Billing and Collections by support Team  |  Comments Off on The Future of Medical Billing for Pediatric Practices

The credit card machine changed the methods that vendors collect bills due from customers.   Prior to the credit card, the customer had to have enough cash on hand, have a check or receive store credit.   Only a few generations ago, businesses needed staff and resources to collect on this store credit.  Once credit cards became available, businesses accepted credit cards for which the business would pay a percent of the charge to cover the costs associated with the credit card company collecting from the customer.   These businesses were able to eliminate or reassign the staff that managed the store credit. 

Medical billing is moving through a similar path.  Prior to the 1990s change to managed care, offices had individuals that prepared the bill and collected from the patient.  If the patient had insurance, the patient would take a receipt from the doctor’s office and submit to their insurance.   As managed care began the process of “In-network”;, offices utilized their billers to submit to managed care companies.  This process started simple (via paper) until the managed care plans invested in computers, software, and coding scrubbers.  Insurance companies learned that the skill of the ‘average’ office as well  as flaw in billing system/methods were not sophisticated enough for their systems.   The managed care plans were able to post strong profits.

Many offices still maintain medical billers.  Some invest well in training, people and Technology, others do not and/or do not know how.  Maintaining a medical biller is very difficult for smaller practices since they do not have enough revenue to justify the cost of a qualified biller as well as appropriate systems.   Even if a practice has the level of revenue to support a medical biller, many are not able to set up and
maintain a medical billing team with appropriate skill sets.   Practice Managers and practice consultants have a portion of their job dedicated to coaching, mentoring, hiring and training medical billers.  Is this
the best model?  Having a medical biller in the office has direct costs, indirect costs as well as an
additional burden to manage.  Interesting that many large Dow 30 companies outsource functions (such as payroll)…..shouldn’t physician practices?

Practices that adopt physicianxpress for EHR and medical billing achieve, to date, 99% collection rate
(contract amount) at a cost that is within the range of benchmarks for backend billing processes.   These practices can audit the claims for their practice real time and they do not need to invest in the cost of a biller, management of the biller, cost of training and retraining.   The medical billers at Doctor Office Management receive quarterly training from various sources (AAPC, AAP, MGMA).    It is much easier to be an auditor and ‘Monday morning quarterback”; than to hire, train, manage and audit a billing team on a continuous basis.  Since payers are becoming more complex to interact with, medical practices will see the benefits of moving the billing operation out of the office.

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