Is Your Billing Company Doing a Good Job?

Is Your Billing Company Doing a Good Job?

How well is your billing company managing your billing for you? Most medical practice owners and physicians would say "okay." How can you be sure? Just because you're getting paid every month doesn't always mean you're making as much money as you should. You could be leaving real money on the table! Here are some questions you should ask your billing company and yourself every month:

Are you receiving payments in less than 30 days?

This is critical when you are growing your business. Ideally you want to know that all of your payments are received and posted within the current month. Most payers pay within 30 days and can even be negotiated in your contract to pay you a late fee if payment is not received in an acceptable time frame. Is this happening in your billing?

Are you collecting at least 40% of what you’re billing?

If the number is 30%, 40% or even 50%, how is your billing company tracking how much you are collecting versus how much you bill in charges? This information is helpful when your payments are lower than average compared to previous months. This can indicate there is a contract issue, coding issue and most importantly that payments are slowing down. Your billing company should be setting up fee schedules correctly and negotiating your contracts properly. Do you know what percentage your billing company is collecting?

Are you following up on accounts before they become 90 days old?

Most timely filing deadlines for payers are 95 to 180 days. If you have claims over 90 days old there is a chance these are not collectible. Claims over 150 days are urgent and probably non-collectible since these claims might not have been received by the payer. On arrival, the claim would be already timely upon resubmission. The most common payers this would affect is Worker’s Compensation and your big commercial payers (UHC, Aetna). Medicare's time is a year so these claims would have more time but will need a prompt follow-up since the claims pay within 20 days of submission. Remember, claims sitting for longer than 45 days = $$$ not collected within the current month. How much money do you have sitting for 90 days or more?

Does your front desk collect at least 25% of total collections each month?

Your front desk is your first line of defense in collecting the patient’s part of your allowable. Let's say your contract with payer states that the payer will pay you a total of $123.00 for an office visit. A copay is due from the patient which is normally at least 25% off the allowable paid by payer ($123.00x .25=$30-copay). These amounts will vary from contract to contract with each payer’s benefits. If your Front Desk does not collect the copays at the time of service, you are missing out on 25% of your collections. This portion is now left up to a statement sent in order to collect the rest of your allowable. In 2009, Medical Group Management Association- MGMA estimated that less than 20% of a practice's revenue came from patients. This is no longer the case today due to high-deductible plans growing 1,000%. Have you trained your Front desk to collect like a Biller?

Are your Physicians' and Mid-levels receiving feedback on documentation and reimbursements?

Most physicians are not coders; most coders are not Physicians.... These 2 people should understand the importance of the other’s position in your business. Your coder should be giving feedback and assisting with correct documentation to interpret your services to your payers. This will ensure the highest payment allowed. When there is a disconnect, there will be a decline in reimbursement. Training should also be offered to help educate the physicians on how to document services provided. Monthly audits and coding reports should be provided by your billing company. Do you know how your Physicians are documenting? If you are struggling to answer these questions, it’s time to get help. Don’t leave money on the table with an “okay” billing company. Hire a better billing company. I highly recommend you contact the WOWZA! Team who specializes in billing solutions for medical practice success. The right team can enhance your bottom line! Contact WOWZA! Management Solutions for more information at 903.831.7270 or visit their website at