CODING & BILLING

S ome of the biggest challenges we face in this industry are staying on top of and interpreting billing standards. Working with a company that’s devoted to surgical billing guarantees you’ll submit claims based on current knowledge of acceptable billing practices and guidelines. Billing is all they do, and most do it well. Partnering with a billing service works exceptionally well for my 9-room, orthopedic-centric surgical facility. We consistently achieve monthly and annual cash collection goals, our unbilled charges average less than 2% per month and our days in accounts receivable are well below the industry average. Those successes are proof of the great relationship and synergy we’ve developed with our billing service. Here’s why you should consider developing a billing partnership of your own. Power in numbers. Large hospitals often have several billing experts on staff, but sur-

gery centers typically have only 1 billing specialist to manage the number of claims generated each month. Now let’s say that billing specialist gives her 2 weeks’ notice or constantly fails to capture all your billable charges. In either case you’re faced with finding a replacement, training that person and getting her acclimated to your billing system. Can you imagine the disruption that would cause to your billing processes and cash flow? Billing services alleviate that potential nightmare. They have enough staff to handle large volumes of claims from several facilities, so you can rest assured that your billing needs will always be met. Potential savings. The basic payment model for billing and collection services is based on a percentage of total cash collected in a month. In my experience, the percentage ranges from 3% to 6% of monthly collections. We took a long look at keep-

Shopping for the Right Billing Partner
H ow do you know which billing service will be a good match for your needs? Research the company’s reputation among your peers. Outsourcing your billing is a big investment and you need feedback to justify your choice. Ask yourself (and others) these questions when shopping around:
  • Will the billing service need additional licenses for your clinical software? If they don’t use your system, be sure to determine that the billing information can flow freely between your systems.
  • How accessible is the billing data? You should be able to easily run reports to quantify the data and results provided by the billing service. The biggest keys for a long-lasting and beneficial relationship are constant communication and feedback between you and your billing reps.
  • How accessible is the billing company? Working with

a billing service in a different time zone could pose logistical challenges in reaching an expert for immediate help or sameday processing of case codes.
• How do they communicate with patients? Your billing service will typically contact patients who are delinquent in paying their deductibles. Asking for money from patients can be a challenging task, one that must be handled with forceful tact. Keep in mind that your billing service will act as an extension of your facility when they contact patients days or months after their surgeries. Are they strong representatives of your staff or will patients be left with the wrong last impression? Listening to your patients’ feedback is the best way to judge a service’s customer service skills. If the billing reps you partner with act inappropriately, your patients won’t hesitate to make you aware of the issue.
— Andrew Summers

ing our billing staff in-house, but when we considered their salaries, benefits and the overhead needed to house and support them, it became a near wash with what we pay our billing service.
Here’s a money-saving tip: When it comes time to negotiate your billing services contract, try to exclude the money you collect on the day of surgery from the total on which the service bases its monthly fees. Your staff has already processed the payments; the billing service simply records the amount on your monthly reports. There should be a reduced rate for that portion.
3 More control. Partnering with a billing service that specializes in such a demanding function lets you oversee the big picture. The time you’d spend hiring, training and managing a competent billing specialist could be better spent monitoring your overall billing performance. For example, instead of managing people and processes, I’m focused on making sense of the billing data generated by our outsourcing service,

particularly our cash flow as a percentage of accounts receivable. Owed money that sits in A/R past 90 days becomes bad debt. If our percentage of bad debt trends toward double-digits, we’re not getting paid in a timely manner. This triggers questions that need to be answered by the billing service. What issues are we seeing? Are unpaid claims linked to a specific payor? Are some payors repeatedly denying the same procedure type? Are they slow paying? Without having to focus on the day-today operations of a billing department, I’m able to drill down to the answers and zero in on fixes. Don’t ever assume that contracted services are on autopilot. Whether it’s looking at metrics and trends each month or even asking questions of your billing service, commit to understanding the reimbursement landscape as if you were handling your billing in-house. OSM