Physicians Practice - September 2008 - (Page 95) CME BILLING GETTING THE PROCESS RIGHT BY GREGORY MERTZ, MBA SHOULD YOU KEEP BILLING IN-HOUSE OR FARM IT OUT? A family physician in New Mexico was quick to tell anyone who’d listen that he didn’t need any billing staff, he did it all himself. Had he discovered a way to drastically cut overhead? Depends on how you define overhead. It was true that he did 100 percent of the work involved in submitting bills, and it was equally true that he spent $0 on staff to help with that process. What he failed to include in the equation is the fact that, after he finished seeing patients, he spent the next 2 to 3 hours entering the information into his software program and transmitting his claims, as well as entering the payments that he received and generating the statements for the patient portion of each bill. While his labor technically didn’t cost money, it was certainly impacting his quality of life. Someone has to perform the functions involved in charge entry, data submission, and payment reconciliation. Who that someone happens to be is not as important as assuring that whatever effort involved is appropriate to the work involved. If you want to get paid for the work that you do, and you don’t LEARNING OBJECTIVES After completing this article, readers will be able to: • Outline the steps involved in the medical practice billing cycle • Evaluate the factors that determine the optimal number of billing staffers needed for a practice an outside billing service • Delineate the pros and cons of using WWW.PHYSICIANSPRACTICE.COM have a cash practice, then someone has to assign codes (CPT and ICD-9) to the care that was given; someone has to enter that information into the data system (all but the smallest practices are now required to send claims electronically); someone needs to collect demographic and insurance information on the patient to be sure that the claim goes to the right place; someone needs to print the claims or transmit them to the insurance plans; and someone needs to match payments received with the charges and handle anything that wasn’t paid and needs to be written off or billed to another insurance carrier or the patient. Physicians often don’t have a good understanding of the revenue cycle because their billing staff is tucked away in a corner and, unless there is suddenly not enough cash to meet payroll, their work is somewhat invisible. Physicians see their nursing and front desk staff almost daily and quickly know what works and doesn’t work and how many people it takes to get the job done. Billers, those invisible folks tied to their computer screens, are far more difficult to understand (they speak a strange language) and many physicians just don’t bother. As revenue becomes ever more critical and overhead must be reduced, or at least controlled, the role of the biller requires closer attention. What should they do and how many should there be? These questions need to be addressed in every practice, on an ongoing basis. Unfortunately the answers are as SEPTEMBER 2008 | PHYSICIANS PRACTICE | 95 http://WWW.PHYSICIANSPRACTICE.COM
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