What does a good billing (RCM) team look like?
Medical billing industry is a very fragmented one in which the typical billing services provider has two people working out of their kitchen (literally). These operators have a hard ceiling at around seven providers that they can provide service to, at which point they are working well over 50-hours per week. That is, if they are diligent and serving their customers in earnest. However, most cannot sustain work at this level of effort. In addition, their reward for this level of work fails to justify the work they put in and they quickly lose focus and consistency. The primary reasons for this situation are the following traits of such billing service providers:
- Lack of knowledge, expertise, & experience
- Absence of a purpose-engineered process
- Deficient technology skills and utilization
- Weak financial skills
These factors result in poor financial and operational performance with the following results for the customers:
- Low reimbursements
- High denial rates
- Growing A/R that is becoming worthless day-by-day due to filing and adjudication limits
- Loss of patient loyalty due to dissatisfaction with patient-facing processes
Some tell-tale signs of this type of billing service provider are:
- Person that signed-on the customer is the same that answers all billing questions
- Claims are handled manually (lot of paper used)
- Claims are not filed same day as received
- Denials are not handled the same day as received
- Payments are not posted the same week as received
The situation does not improve for most organizations that decide to do their billing in-house – although it seems like a better option on the surface due to the assumptions that:
- It will cost less:
In fact it costs 35% or greater more than the outsourced option
- It will provide better control:
In fact it produces less control and more management overhead and headaches due to labor rules and laws
- It will provide cheaper growth:
In fact it does the opposite. In-house staff is harder to motivate for efficient growth as they are not compensated for greater volume. So the growth in volume means growth in head-count and expenses
Making a decision about whether to do billing in-house or outsource it to a service provider is a tough one for most people. Further deciding which outsourced service provider to go with is a decision fraught with financial risk as well as one that can paralyze a practice, facility, clinic, or a lab.
If you find yourself in this decision-making dilemma, please contact us and we will put you in direct contact with someone who had to go through a very similar situation. Talk to them. Ask questions. It will all be between you and someone in the same field as you and not vested in any billing service.
That’s the most honest and transparent advice we can give yo in this regard.