The two chiropractors were chatting. One was an older, experienced doctor. He had tried it all -- low volume, high volume, cash, insurance, care plans, fee-for-service. And several times, he had tried to outsource his billing -- and failed. The younger doctor, having practiced for only a couple of years, had just brought up the subject of billing, and remarked at how time-consuming billing had become for his growing practice.
His CA, he estimated, was now spending almost 20 hours per week entering charges, sending claim batches, printing and submitting secondary claims, and posting EOBs. With all her other duties, there was less and less time for claim follow-up, and the younger doctor was concerned that patients were not getting the personal attention they deserved. Worse, he was working harder, but revenues seemed to decrease as claim after claim was simply not paid. He finally said it: "I'm looking at hiring a billing company. Got any ideas?"
The older, wiser doctor immediately frowned. His experience with traditional billing companies were complete and utter disasters. Each time, he had had to move the billing back in-house, find and train new staff and recover from financial issues. The billing companies he tried were simply not equipped to handle his volume of claims. Besides, there were lots of other issues.
"Such as?" asked the younger doctor, obviously distraught at the prospect of having to hire and train a separate billing clerk for his office. He had hoped there was a simple solution - a silver bullet that he could simply sign up for and that would let him get back to doing what he loved -- treating his patients.
"Control, for one," answered the older doctor, still frowning. It was a problem that plagued almost every billing service out there. Billing services tend to work in their own software systems. It makes them more efficient at follow-up and data entry, since their billers need to learn only one system. It also allows them to monitor and control all employees centrally. But it wreaks havoc on the provider's office. Few billing services provide any kind of remote access to their billing system. Often, remote access is slow and cumbersome, and the office never utilizes it. It's hard to run a practice when the vital statistics are so hard to access. Harder still to control the billing and follow-up process when the claims and audit trails are out of reach.
And that was just for starters. Lack of efficiency followed lack of control. With in-house billing, the charges flowed from one screen to the next, with no paperwork in-between. Once the process and data were moved out of the office, the staff started spending hours faxing superbills to the billing company. The faxes invariably died in the middle or came back as unreadable, causing no end of frustration.
But that wasn't the worst of it. "See, the problem is that traditional medical billing companies are built for traditional medical doctors." Now the older man was philosophizing. "We're different in many ways, but one of the most important ways is in our patient visit average. Chiropractors sometimes see dozens of visits for each of their patients. The coding and documentation is almost identical every visit. It's only if you look at an interval of time - say 12 visits - that you can see large-scale improvements in the patient's health and treatment."
"That's why a higher volume practice cannot survive without a powerful in-house system that helps you produce documentation and claims by making minimal changes every visit, and not recreating an entire encounter every time you adjust someone. Now, all of the sudden, you have two systems. One for managing your practice and seeing patients. and the other, for doing your billing. The two systems can't talk to each other, so everything becomes fragmented and things get missed."
"For example, last week I had a patient walk into the office for a routine adjustment. As soon as he scanned into my front-desk kiosk, an alert came up telling my CA that some of his previous claims had begun failing because his carrier was waiting for an insurance survey from him. If the billing system hadn't been talking directly to the front-desk check-in system, we would have missed that and could have continued treating him for free for months."
The young man look awed. His current system didn't do that. He asked the older doctor what system he was using. "Billing Precision," came the answer. Now the young doctor was confused. Billing Precision? Wasn't that a billing company? It certainly sounded like a billing company. But, then, what was the old guy talking about? He had to find out.
"Do you mean your software is called Billing Precision?" he inquired.
"No," responded the older man. "The software is Vericle. I outsource my follow-up and EOB entry to a company called Billing Precision, and they supply me with the software. Billing Precision is not a traditional medical billing company. Their software is web-based, so it's really my office software. I use it just like a regular practice management system. But the best part is that Billing Precision accesses it from their location to do their follow-up and EOB entry."
"It gives me the best of both worlds. I get the efficiency and control of an in-house system, without having to continuously hire and train billing staff. My patients' charts come up automatically at each adjusting station when they scan their key-chain tags. It takes me 10 seconds to document and bill a repeat visit at the table. The data is then automatically pushed to the insurance companies or accrued on the patient's account if it's a cash patient. The whole process takes seconds."
"I also get real-time access to my vital stats and all of my financial reports. Not just in the office. I took a trip to Italy last summer. Halfway through, I really wanted to see how my associate doctor was doing while I was away. I logged on to the system from an Internet Cafe, and in seconds, I was able to see reports and stats."
The young doctor was hesitant. It sounded very different from the typical in-house or outsourced setups he had read about or seen in other offices. "Does it work?" he asked.
"It worked for me," mused the older man, "but I knew what I was getting into. I had experienced both traditional approaches to billing and I knew both didn't work for me. I wanted to focus on building my practice without having to train and manage a team of billers, but I didn't want to give up control of my billing. This was the only solution that let me have it both ways."
The older man smiled and thought back to the first time he talked to Billing Precision and received a demo of the software. It looked nice, but his stomach was doing backflips at the thought of another outsourcing billing nightmare. Now that everything was up and running, he was glad he made the right decision.
He was concerned for the young doctor. Would he appreciate the benefits of Billing Precision's non-traditional service without first experiencing the pain of traditional approaches? He thought about that for a while.
"You have to decide for yourself," he finally said.
Thursday, December 4, 2008
Tuesday, November 25, 2008
Client Screening Conversation
Recently I had a conversation with a potential client concerning his trepidations about joining Billing Precision. He mentioned that he spoke with several clients that were ecstatic about our service, but he wanted to know what the negatives were. In other words, what did clients who did not have a perfect experience with Billing Precision have to say about the service? What negative experiences could he learn from? And most importantly, what makes a client a "bad fit"? What type of clients would do better billing on their own or with a different billing service?
Billing Network
We started by looking at the concept of a Billing Network, which bands together many smaller practices so that they can benefit from each others' experience and contribute to the greater good. This is in stark contrast to an in-house billing process, where each provider has their own system and has an isolated view of only their own claims. In the contest between Payers and Providers, Payers already have an aggregated view of many providers and are able to benefit from a large data set, more efficient processes, and more streamlined management.
Whereas each individual provider needs to develop their billing processes and controls, hire a good operations manager, and continuously train and tweak the process to keep up with the payers, the payers do it once and apply it to tens of thousands of providers. This is one of the reasons why it's easier for payers to offshore their operations and benefit from the lower cost of labor.
A "good fit" client for Billing Precision has a very thorough understanding of this concept. They understand that even if they could hire someone at a lower hourly rate than the commission that Billing Precision charges, that the person they hire would likely not be able to build and manage a complete and efficient billing process, and they would definitely not have access to the large data set available to the Billing Network. Clients that do not get this concept are forever comparing their cost of billing to what they would pay per hour for someone to work part-time on their claims and forget about the benefits of being in a Billing Network.
Good clients are looking to contribute to the network where possible. When they run into problems, they are determined to help Billing Precision identify the core problems and improve our processes so that others do not have to trip over the same landmines.
Commitment
The next issue is staff commitment. In any practice, the commitment level of the staff often determines whether or not an office becomes a content, successful participant in the Billing Network. Staff members are often fearful of change or resentful of the extra work required to make the practice successful in billing. Such team members can easily sabotage the process or the relationship and lead to a complete disaster. Anything from not submitting EOBs, not working the workbench, or simply infusing the process with a negative attitude have all led to failure of the office to benefit from the Billing Network.
Often, lack of staff commitment to joining the Billing Network is just a symptom of overall lack of staff control in the office. It's amazing to see the difference between very successful offices who are often seeing 1,000-1,500 visits per week with 3-4 staff members, vs offices struggling to see 100 visits per week with a staff of 2-3. It starts at the beginning of the engagement. One of our high-volume practice owners began the integration process by gathering his team together and telling them that:
Workbench and Accountability
Once the staff is committed, they must be actively managed and made accountable. We are often asked about the "workbench" and the amount of "extra work" that it adds to a practice. The workbench's function is precisely to make the staff accountable and help the practice owner manage the process without having to look at every claim. The workbench effectively "opens the billing drawer" and exposes all the claim rejections and unpaid services that are typically hidden by billers and billing companies. Successful practices implement a policy whereby no one leaves the office until the workbench is clean.
Reconciliation
Another pitfall is lack of reconciliation. Many client issues stem from a misunderstanding about how Billing Precision computes the monthly invoice to the client. Billing Precision receives and posts both EOB and ERA (electronic EOBs) without confirmation of whether the money actually was deposited into the provider's account. The reason is simple: Billing Precision has no access to the provider's account and therefore completely depends on the provider to reconcile their bank statement to the monthly check report to make sure all the money was deposited by the practice.
Any provider that does not reconcile their payments runs the risk that the insurance companies make a mistake and send ERAs without sending the money, or worse, that checks and EOBs are received by the office, but that the checks somehow get lost before being deposited. This could quickly lead to a misunderstanding where the office believes they are being overcharged for money that was posted as collected by Billing Precision, but was not actually deposited into the provider's bank account. It is therefore absolutely imperative for the practice to reconcile their statements at least on a monthly basis and notify Billing Precision immediately if any checks are posted as paid in Vericle but not received by the practice.
Support Protocol
Finally, practices often have an unrealistic expectation of how quickly Billing Precision can respond to their support requests. Billing Precision and Vericle support a complex organization of technologists and billers who are constantly working to improve the technology and follow-up on claims. Constant phone interruptions by practices decimate productivity of all Billing Precision and Vericle employees as they struggle to switch between the tasks that they are trying to accomplish and the problems and questions posed by the clients. On demand phone support also leads to long hold times (average hold time for BCBS NJ is 22 minutes!) and very frustrated clients.
Billing Precision believes in empowering clients to find solutions on their own and at their convenience. Providers and their staff must be willing to take initiative and search the available web resources for their answers. Of course, we recognize that sometimes the information needed is simply not available in the online resources. In those cases, offices can register and join the daily QA sessions and ask their questions in a group settings. Alternatively, they can open a ticket directly from the Home screen and let the appropriate team respond within 1-2 days.
Summary
After reviewing these items with the doctor, I suggested that he take some time and really think about whether his practice is a good fit for our service. Does he understand the benefit of joining a Billing Network? Does he want to contribute to the greater good and help all members benefit from his experiences, just as he benefits from theirs, or will he expect perfection and leave at the first sign of trouble? Does he have the complete commitment of his staff? Are the staff members "self-starters" that can try to resolve issues on their own or simply open tickets and wait for replies, or will they demand instant hand-holding and instant results?
The doctor took a deep breath and thought for a moment. He tried to visualize his staff grappling with the workbench while trying to learn a new system. He imagined their frustrations and complaints at having more work to do. He considered whether he really believed in the concept of doctors banding together and learning from each others' mistakes through a unified system. Then, he thought about the insurance companies and how unfair it was for them to be able to benefit from their large scale and all the data available to them. He thought about hundreds of billers in India fighting for his claims and using the aggregate knowledge gained from processing hundreds of thousands of claims every month. He thought about our successful client and how he was able to rally the troops and implement the system quickly and efficiently. He imagined his practice discovering a flaw in the process, and working with Billing Precision to correct the flaw and help hundreds of practices across the country avoid the same mistake.
His decision, at the end, was a personal one. Whether he decided to join the network or go it alone is not nearly as important as the thought process behind it. For the Billing Network to benefit everyone, all providers in it must be "on mission". As Aristotle put it "The whole is greater than the sum of its parts." Or, if you prefer: "All for One and One for All."
Billing Network
We started by looking at the concept of a Billing Network, which bands together many smaller practices so that they can benefit from each others' experience and contribute to the greater good. This is in stark contrast to an in-house billing process, where each provider has their own system and has an isolated view of only their own claims. In the contest between Payers and Providers, Payers already have an aggregated view of many providers and are able to benefit from a large data set, more efficient processes, and more streamlined management.
Whereas each individual provider needs to develop their billing processes and controls, hire a good operations manager, and continuously train and tweak the process to keep up with the payers, the payers do it once and apply it to tens of thousands of providers. This is one of the reasons why it's easier for payers to offshore their operations and benefit from the lower cost of labor.
A "good fit" client for Billing Precision has a very thorough understanding of this concept. They understand that even if they could hire someone at a lower hourly rate than the commission that Billing Precision charges, that the person they hire would likely not be able to build and manage a complete and efficient billing process, and they would definitely not have access to the large data set available to the Billing Network. Clients that do not get this concept are forever comparing their cost of billing to what they would pay per hour for someone to work part-time on their claims and forget about the benefits of being in a Billing Network.
Good clients are looking to contribute to the network where possible. When they run into problems, they are determined to help Billing Precision identify the core problems and improve our processes so that others do not have to trip over the same landmines.
Commitment
The next issue is staff commitment. In any practice, the commitment level of the staff often determines whether or not an office becomes a content, successful participant in the Billing Network. Staff members are often fearful of change or resentful of the extra work required to make the practice successful in billing. Such team members can easily sabotage the process or the relationship and lead to a complete disaster. Anything from not submitting EOBs, not working the workbench, or simply infusing the process with a negative attitude have all led to failure of the office to benefit from the Billing Network.
Often, lack of staff commitment to joining the Billing Network is just a symptom of overall lack of staff control in the office. It's amazing to see the difference between very successful offices who are often seeing 1,000-1,500 visits per week with 3-4 staff members, vs offices struggling to see 100 visits per week with a staff of 2-3. It starts at the beginning of the engagement. One of our high-volume practice owners began the integration process by gathering his team together and telling them that:
- He has made the decision to join the Billing Network
- The transition will be difficult for everyone
- He expects 100% staff cooperation and commitment
- Anyone who can't commit to delivering 100% should leave now
Workbench and Accountability
Once the staff is committed, they must be actively managed and made accountable. We are often asked about the "workbench" and the amount of "extra work" that it adds to a practice. The workbench's function is precisely to make the staff accountable and help the practice owner manage the process without having to look at every claim. The workbench effectively "opens the billing drawer" and exposes all the claim rejections and unpaid services that are typically hidden by billers and billing companies. Successful practices implement a policy whereby no one leaves the office until the workbench is clean.
Reconciliation
Another pitfall is lack of reconciliation. Many client issues stem from a misunderstanding about how Billing Precision computes the monthly invoice to the client. Billing Precision receives and posts both EOB and ERA (electronic EOBs) without confirmation of whether the money actually was deposited into the provider's account. The reason is simple: Billing Precision has no access to the provider's account and therefore completely depends on the provider to reconcile their bank statement to the monthly check report to make sure all the money was deposited by the practice.
Any provider that does not reconcile their payments runs the risk that the insurance companies make a mistake and send ERAs without sending the money, or worse, that checks and EOBs are received by the office, but that the checks somehow get lost before being deposited. This could quickly lead to a misunderstanding where the office believes they are being overcharged for money that was posted as collected by Billing Precision, but was not actually deposited into the provider's bank account. It is therefore absolutely imperative for the practice to reconcile their statements at least on a monthly basis and notify Billing Precision immediately if any checks are posted as paid in Vericle but not received by the practice.
Support Protocol
Finally, practices often have an unrealistic expectation of how quickly Billing Precision can respond to their support requests. Billing Precision and Vericle support a complex organization of technologists and billers who are constantly working to improve the technology and follow-up on claims. Constant phone interruptions by practices decimate productivity of all Billing Precision and Vericle employees as they struggle to switch between the tasks that they are trying to accomplish and the problems and questions posed by the clients. On demand phone support also leads to long hold times (average hold time for BCBS NJ is 22 minutes!) and very frustrated clients.
Billing Precision believes in empowering clients to find solutions on their own and at their convenience. Providers and their staff must be willing to take initiative and search the available web resources for their answers. Of course, we recognize that sometimes the information needed is simply not available in the online resources. In those cases, offices can register and join the daily QA sessions and ask their questions in a group settings. Alternatively, they can open a ticket directly from the Home screen and let the appropriate team respond within 1-2 days.
Summary
After reviewing these items with the doctor, I suggested that he take some time and really think about whether his practice is a good fit for our service. Does he understand the benefit of joining a Billing Network? Does he want to contribute to the greater good and help all members benefit from his experiences, just as he benefits from theirs, or will he expect perfection and leave at the first sign of trouble? Does he have the complete commitment of his staff? Are the staff members "self-starters" that can try to resolve issues on their own or simply open tickets and wait for replies, or will they demand instant hand-holding and instant results?
The doctor took a deep breath and thought for a moment. He tried to visualize his staff grappling with the workbench while trying to learn a new system. He imagined their frustrations and complaints at having more work to do. He considered whether he really believed in the concept of doctors banding together and learning from each others' mistakes through a unified system. Then, he thought about the insurance companies and how unfair it was for them to be able to benefit from their large scale and all the data available to them. He thought about hundreds of billers in India fighting for his claims and using the aggregate knowledge gained from processing hundreds of thousands of claims every month. He thought about our successful client and how he was able to rally the troops and implement the system quickly and efficiently. He imagined his practice discovering a flaw in the process, and working with Billing Precision to correct the flaw and help hundreds of practices across the country avoid the same mistake.
His decision, at the end, was a personal one. Whether he decided to join the network or go it alone is not nearly as important as the thought process behind it. For the Billing Network to benefit everyone, all providers in it must be "on mission". As Aristotle put it "The whole is greater than the sum of its parts." Or, if you prefer: "All for One and One for All."
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