Published - February 2013

By Dave Jakielo

The Medical Billing Industry is Changing. Are You?

We have all heard the saying, "The more things change, the more they stay the same." Well, that saying just does not hold water any more. The medical billing industry is changing more today than I have seen in my five decades in this business.

It's not doom and gloom if you are willing to change and adapt, but if you just keep doing things the way you have always done them -- you'll slowly or rapidly go out of business.

Here are some of the differences working in medical billing in this decade versus only a decade or two ago...

We now need knowledge workers on our staffs. Most of the non-complex and repetitive tasks such as data entry and payment posting have been automated, thereby eliminating the need to have people on our teams that just copy and key. These workers must be retrained. One option is for them to learn how to investigate and solve the accounts receivable challenges we face on a daily basis that relate to denials and rejections. The problem is not everyone can be retrained. Some may have to be freed up for other opportunities in other industries.

Today, you can't afford to have any marginal employees. Everyone needs to generate more income than they cost. Remember, having an employee that only gives you 50 percent and having one who gives you 150 percent doesn't equate to two employees at 100 percent each. Clean out your dead wood.

Interactions with clients have to be increased. The adage, "no news is good news," may have been true in the past but today customer loyalty is dead and we all know most physicians are non-confrontational. If you are not continually staying in front of you clients via:

  • Personal visits
  • Telephone calls
  • Email
  • Snail mail

Then your competitors probably are.

Today's competitors are not just other billing companies, they include: hospitals, other mega practices, accountable care organizations, et cetera.

Given that many doctors are non-confrontational, they may make a decision to go in another direction with their practice and not even ask your advice. You will find out after the fact when they send you a termination letter. So find reasons and ways to be in touch, at least monthly.

Another area that needs to change is what we call end of month reports. All systems produce monthly charges, adjustments, payment and accounts receivable aging reports. Do you want to be like all other billing companies with the same menu of generic reports? Hopefully you answered no.

So how can you differentiate yourself? By compiling reports that are packed with information, not just data. Your reports should help your clients stop doing what is unprofitable and start doing more of what is profitable. Here are some reporting ideas.

  • Comprehensive report listing all denials and rejections along with the reason codes so that policy and procedures can be put in place to minimize unpaid claims.
  • Listing of accounts that are paid in full by zip code so the client knows where their money is coming from and can continue to advertise in those areas.
  • Help your client determine the cost of the visits and procedures they provide. Are they conducting any tests in their offices that cost more than the revenue they produce?
  • A referring doctor report by patient payer type. Until you look at an analyze this report you may find that the biggest referring doctor is sending the practice low pay or no pay patients and they are referring the better pay class patients to another practice.

I'm sure if you and your team sat down at a bag brown lunch in your conference room together you could come up with a dozen or more reports that would turn the data residing in your system into valuable information for improving your clients' practices.

The reality of today's healthcare marketplace is that there will be fewer practices out there looking for billing services. Naturally, not all companies will survive. However, the choices is yours. You can take a proactive approach and improve your company and move it to the next level. Or, you can "stay the course" and the only decision you will need to make is who will shut the lights off when the last client leaves.

Dave Jakielo, CHBME, is an International Speaker, Consultant, Executive Coach, and Author, and is President of Seminars & Consulting. Dave has been helping Companies grow and improve their profitability for over four decades. Sign up for his FREE weekly Success Tips at Dave can be reached via email; phone 412-921-0976.

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