Doctors are too busy running their practices to be constantly worrying about which codes are best to bill, or spending time trying to understand the implications of changes in codes. To alleviate this pain, doctors will often turn to billing management services, agents, or hire staff to manage their billings. For the most part, these arrangements work – bills get submitted and doctors get paid. But, how do you know if you are getting the most out of your billing management services? We have worked with thousands of doctors and while the billing basics seem to be covered, often there are areas where doctors are in the dark.
Here are three key areas you should be talking to your billing management resource about to ensure you are maximizing your revenue.
Billing errors: Are you getting paid for all the work you do?
Billing errors is one of the most common gaps we see with doctors maximizing their revenue and, in most cases, they have no idea if their errors are being fixed or even if they can be fixed. Here are some things to be thinking about with your billing provider or staff to ensure your errors are being caught and fixed:
- Are you getting reports on errors and if they were fixed/resubmitted?
- Do you know what your most common errors are so they can be avoided in the future?
Fixing errors is one of the easiest and quickest ways to recover revenue but often gets overlooked. One key metric you should be looking for is the percentage of your rejected claim/errors you are retrieving. If you aren’t retrieving at least 85% of your rejected/error billings then you could be missing revenue for visits you have completed. In some cases, we have seen tens of thousands of dollars in lost revenue recovered simply by resubmitting billing errors and rejected claims.
Billing frequency: Is your billing happening weekly?
We know that batch billing makes doctors nervous but if your billing management provider gets behind by a couple of months or gets sick, the billing backlog can accumulate very quickly. Regular billing submissions, ideally on a weekly basis, prevents situations where revenue may be at risk due to expiry and can also help reduce errors or missed claims. Billing backlogs can be costly, and we have seen this firsthand. In the case of one doctor, a six-month billing backlog equated to over $170,000 in one RA. Billing the right things, at the right frequency with minimal errors can also help you maintain predictability in your pay, identify billing trends, and avoid a MOH audit.
Partners in practice: Do you have the full picture of your revenue and optimization opportunities?
You are paying for billing management, so how do you know if everything is going smoothly? EMRs do not have great reporting so you need to rely on your billing management provider for full transparency into what you are billing for and errors corrected so you can be sure you are getting paid for the work you have done. On a regular basis, your billing agent or service proactively providing you detailed reporting on:
- Codes billed and errors fixed that reconcile to your pay statement.
- Data comparing how you are doing compared to peers.
- Areas where you could be optimizing your billings through alternative or additional codes (for example, virtual care).
If you haven’t had a conversation with your billing agent or service in the last 12 months (or ever) then you could be losing revenue earned and visibility into opportunities to improve your practice.
At the end of the day, whoever is managing your billing whether it’s an independent agent, a larger service, or a staff member – they need to be a partner in your practice and have the expertise to get you paid.
We believe billing shouldn’t be complicated, hard, or expensive and our services take the worry and work off doctors’ plates. To get started, DoctorCare provides a complimentary audit of your billing practices to help you identify areas where you may have gaps including a comprehensive review of your billing errors, timeliness of billing submissions, and opportunities for billing optimization so you can have an in-depth, detailed view of where you can improve.
