Small and large practices alike must decide whether it is better for them to do their medical billing in-house or to outsource their billing to a medical billing service, such as Promedico, the preferred Billing Partner of the Santa Clara and Monterey County Medical Associations. There are many factors to consider before making this choice, but ask yourself: would you perform your own hip replacement? Medical billing requires an ever changing set of skills and at times can be quite complex. Often, a local medical billing company can provide the best revenue management cycle for your practice. Let’s start with the billing staff. Medical billing companies hire individuals who have a desire to work in the billing field. They hire trained and skilled workers who have already achieved a level of competence. Many billers also possess either a certificate of achievement in billing or have become certified professional coders. This takes the guess-work out of billing and ensures correct coding at all levels. In fact, one of the most common denials is for codes not being medically necessary. Experienced billers know how to code and are aware of potential denials before the bill is ever sent out. A billing company has multiple billers, and those individuals often collaborate to ensure clean bills are sent right the first time. Secondly, as you are aware, the industry is ever changing. Each year there are new codes, both procedurally and diagnostically. Did you know that ICD-10 changes take effect every year in October, for the upcoming year? Or that the CCI edits are updated quarterly? The software that most billing companies use is equipped to handle the required changes. Most billing companies provide ongoing education for the billing staff. In addition, billing companies use the top of the line billing software such as Ingenix Encoder pro or Code X, to assist them in insurance appeals and to avoid unnecessary bundling. Billing companies are always aware of the reimbursement trends. They can often offer advice on whether or not to consider certain PPO or HMO networks or even if you should accept the Covered California Plans or Medi-Cal. 46 | THE BULLETIN | MAY / JUNE 2016
Medical billing companies have “economies of scale” and can help keep your costs down. You do not need to hire additional staff and pay worker compensation benefits or additional payroll taxes, not to mention health benefits and 401K contributions. You do not have to spend additional costs for updating software or because there is an increase in the postal rates. You will not have to purchase additional hardware or provide more desk space in your office. A billing company can operate at a lower rate and pass those savings on to you. Perhaps the most important reason for choosing outsourced billing is for cash management. With the rising costs of running a medical practice, cash flow becomes a major factor. Most billing companies will have clean claims going out faster and with fewer errors. Electronic submission and receipt posting means faster turnaround time for your payments. Your goal should be to get the highest payment in the shortest time. If an in-house biller is on vacation for a week or two, no bills are being sent out, and no payments are coming in. Most billing companies have support to handle this very issue so your cash flow is never interrupted. Finally, physicians should focus on what they do best. If you can spend your time treating patients and not worrying about writing appeals or wondering if the clearing house got your bill, you will be less stressed and more focused on patient outcomes. Let your medical billing company handle the insurance problems and the patient billing questions. Let them handle your contracting and credentialing issues. Medical billing companies can advise you on many aspects of your practice, not just billing. Remember, you set out to be a doctor, not a medical biller. So let the professional medical billers do what they have been trained to do. This will allow you the time with your patients to be the best physician you can be. Promedico offers a free Billing Audit and Consultation, in addition to a fee discount, to all Santa Clara and Monterey County Medical Association members. The Non-Member cost is $495.00. Promedico can be reached at 408/680-0000.