| If you give a pig a pancake... Everyone knows | | | | companies are created equal. |
| what happens in that children's book. The pig | | | | Traditional Billing |
| wants more, and more, and more. We don't have | | | | The term "billing company" describes precisely |
| to spell out the analogy. Insurance companies | | | | what traditional outsourced billing services do: they |
| have been taking pancakes from providers for | | | | bill. Their entire business model is wrapped around |
| years. Every year, they come back for more. | | | | entering charges into a billing system and filing the |
| Recently, Pacificare was found guilty of incorrectly | | | | claims on behalf of the provider. Fighting for claims |
| processing 30% of claims. Give an inch, take a | | | | is an afterthought. When the overworked billing |
| mile. | | | | company staff has time, they look through aging |
| Make no mistake, providers are locked in a power | | | | reports and call on outstanding balances. Thus, a |
| struggle with insurance companies, who have the | | | | practice that entrusts a traditional billing service |
| advantage in size, technology, people, and | | | | with fighting for reimbursement very often |
| processes. It costs more today to fight for | | | | suffers from lower collections than when they |
| proper reimbursement than ever before. And the | | | | were fighting for reimbursement in-house. |
| payers are escalating the battle. Post-payment | | | | Fighting Services |
| audits, refund requests, underpayments, partial | | | | Enter the new breed of billing services: Claim |
| payments, late payments, and flat-out denials | | | | Fighting Services. Claim Fighting Services are built |
| proliferate and constantly knock practices | | | | around follow-up. Everything else supports that. |
| off-balance. They waste time, energy, and focus. | | | | Unlike billing services, fighting services are built |
| Recently, practices have asked: "Is it worth it?" | | | | from the ground-up to wage war for |
| "Why don't we just accept whatever they pay us | | | | reimbursement. First, they have dedicated staff |
| instead of fighting for what's ours?" On the | | | | for follow-up. The follow-up staff has no other |
| surface, it seems plausible -- save a lot of money, | | | | job. They are the soldiers, and they are never |
| time, and energy on fighting a $10 "processing | | | | distracted from their mission. They make up the |
| error". It costs more to fight for the $10. But the | | | | bulk of the fight services staff. |
| results can be disastrous. Giving up $10 today tells | | | | Next, fighting services automate everything |
| the payer that we're content with the lower | | | | possible that distracts from the fight. Claim entry |
| reimbursement. The next step is to ask for more. | | | | is done at the provider's office. Errors are flagged |
| $10 turns into $15, $20, the entire payment. | | | | up-front and dealt with at the time of service. |
| Reimbursements drop lower and lower -- an | | | | Claim submission is fully automated. |
| endless spiral. | | | | Reimbursements are auto-posted where possible. |
| But that's not the worst part. Lack of action on | | | | Nothing extra is added. Every feature is focused |
| certain denials may red-flag an office for a costly | | | | on one thing: helping the fighting service fight for |
| audit. For example, if services are routinely | | | | reimbursement. |
| submitted and denied pending medical records, and | | | | Fighting services require accountability. Every biller |
| a practice refuses to send the records, the | | | | (read soldier) has a workbench -- a target list -- |
| obvious conclusion is that the practice doesn't | | | | that tells them precisely which claims to work |
| have those records -- a nice juicy target for an | | | | today. Managers oversee the process and make |
| audit. | | | | sure that workbenches are completed daily so |
| We know that appeasement is not a long-term | | | | claims never wait more than necessary before |
| solution, especially when practiced with an | | | | being sent back to the payers. Accountability |
| adversary who is constantly looking for ways to | | | | works both ways. A significant portion of claims |
| fatten the bottom line. The only solution is to | | | | need provider input before the fight can continue. |
| fight. But how? | | | | Fighting services have a system to make |
| Outsourced Billing | | | | providers accountable so that every claim is |
| Hiring staff to fight for claims and take action on | | | | worked, even if it needs provider input. |
| denials is not for everyone. Staff adds a fixed | | | | The Long Road Ahead |
| overhead and needs constant management. | | | | Fighting services are not a panacea. They are only |
| Vacation days, sick days, health insurance -- all | | | | as effective as the providers that they represent. |
| take their toll on a small business. And then | | | | They form a partnership with the provider, in |
| there's the constant, nagging question: "Now that I | | | | which the key ingredient on both sides is |
| have an effective biller, what happens if I lose | | | | commitment. Commitment to continually improve |
| them?" | | | | the process on both sides. Commitment to keep |
| Small practices often turn to outsourced billing | | | | open the lines of communication between the |
| companies to fight for their money, entrusting the | | | | provider and the service to prevent payers from |
| billing company to carry the fight for them, | | | | sowing the seeds of doubt. Most of all, |
| without distracting the practice from its primary | | | | commitment to work together to surmount all |
| mission of serving patients. But not all billing | | | | obstacles and make the payers pay. |