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The Medical Billing Industry is Changing. Are You?


An article by Dave Jakielo, CHBME, taken from the January/February 2013 issue of HBMA Billing.

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 on doing things the same way, you will slowly (or rapidly) go out of business.

We now need knowledgeable 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 who just copy and key. We must retrain these workers. One option is for them to learn how to investigate and solve the accounts receivable challenges that we face on a daily basis related to denials and underpayments. Unfortunately, we cannot effectively retrain everyone – some may have to be freed up for other opportunities in different industries.

Today, you cannot afford to have any marginal employees – everyone needs to generate more income than they cost. Remember, having an employee who only gives you 50 percent and having another one who produces 150 percent does not equate to two employees at 100 percent each. Clean out your dead wood.

Interactions with clients must 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 your clients via personal visits, telephone calls, email, and snail mail, your competitors probably are. Today, competitors are not just other billing companies: they include hospitals, other mega-practices, and ACOs, to name just a few.

Given that many doctors are non-confrontational, they may choose to go in another direction with their practice without discussing it with you. 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 relates to the ways we prepare end of month reports. All systems produce monthly charge, adjustment, payment, and accounts receivable aging reports.

How can you differentiate yourself? Provide reports that are packed with information – not just data. Your reports should help your clients stop doing what is not profitable and start doing more of what is profitable. Here are some reporting ideas:

  • Produce comprehensive reports listing all denials and rejections along with the reason codes so you can implement policies and procedures that will minimize unpaid claims.
  • Offer listings of accounts that are paid in full by zip code so that 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?
  • Provide a referring doctor report by patient payor type. Until you review and 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 paying patients to another practice.

I am confident that if you and your team sat down at a brown bag 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 looking for billing services. Naturally, not all companies will survive. The choice, however, is yours: you can take a proactive approach, improve your company, and move it to the next level, or you can "stay the course" where the only decision you will need to make is who will shut out the lights 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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