When it comes to billing services: Buyer Beware

---

The saying, "You get what you pay for," applies with medical billing services. In the current business atmosphere businesses are needing to economize, but most times when you economize your billing service you end up losing more money than you save. There are many intricacies involved with billing and seemingly simple errors can cause you to be paid less than the amount that you have earned. These errors add up quickly and have a huge impact on financial stability. 

In a perfect world, the simple circular flow chart would represent all claims submitted and then paid. It represents the ideal, not reality. A good question to ask is: What percentage of primary insurance claims submitted to the insurance companies are getting paid from the first submission - without any errors or denials? There are published bench-marks that can guide your expectations for payment from new claims. We succeed at keeping your revenue at levels better than the industry standard.

It has shocked us to find out how some of the new Revenue Cycle Management billing software processes denied or partially paid insurance claims. At many billing companies, their personnel are not knowledgeable in the complexities of billing both medical and vision insurance claims. They will automatically re-send the same claim to the insurance company without any revisions or corrections. Without corrections, communication with the insurance company, or insurance specific adjustments/corrections made to the claim, the most likely response will be the same explanation from the insurance company of why the claim is not being paid or they will deny it as a duplicate submission.

 Why would they do this? Depending on software set up, the re-sent claim's aging restarts in the computer system, and the accountability for the age of this claim is reset. This same trick is performed by unscrupulous billing staff for the exact same reason. Unfortunately doing this is very harmful to the practice's ability to forecast finances and analyze areas to improve.  

Billing services are being out-sourced to foreign countries where English is not the main language spoken. The out-sourced companies that I have needed to interact with have been extremely rude to the practice's staff, to myself, and even to the CEO's and doctors. OBS views themselves as an extension of your office. We strive to interact with others, on your behalf, in a polite and respectful manner.

When the service company you have hired treats practice personnel rudely and unprofessionally, imagine how they treat your patients. Your billing service/staff represents the practice, and it is imperative that they treat patients with patience, kindness, and respect. 

A few thoughts on patient retention:  Some of the best practitioners have lost many of their patients because of incompetent, untrained, or callous billing staff. 

These patients love their doctor but going to this doctor is not worth the hassle that inevitably comes with the bill. These patients will move on until they find a good doctor who has a great support staff. When they share their experience about your practice, the comments might include how great the care was, but the emphasis will be about the frustration they experienced with your staff and with the bill. 

Patients have power on doctor rating sites and these ratings directly affect the number of patients you see. Prospective patients can usually see past the postings from whiny patients that are overly picky and overly critical. What prospective patients don't miss is a practice that overcharged, quoted the wrong costs, or sent someone to collections when it wasn't justified. A very poor rating with justification will be shared with more people than a dissatisfied patient could ever could talk to directly. A negative experience with your billing staff will definitely detere other people from entering your doors, costing you money.

My personal experience has been that older patients will gladly share their opinions about care-givers and their billing department. Most of the 65 and older crowd that I know have Facebook accounts, are well connected, and not afraid to use it.

Why is this important? It is important for several reasons: 

1. The 2017 census reported that 14.9 percent of Americans are aged 65 and older.  
2. 62% of online Seniors over the age of 65 use Facebook or other social media. This number is growing.
3. Many patients 65 and older are on fixed incomes. 
4. As a group they have a reported median income of $38,515, but half of this population has income lower than $26,200. 
5. Future growth expectations: In the next 25 years this demographic group is expected to double to approx. 30%.
6. Most of the patients in this demographic are using Medicare and Medicaid.

Some of the saddest situations that I have experienced with billing have been while cleaning up the accounts of a new client. I will share one example (of many)-no names included:

An older female patient contacted me about her bill. She had been quoted a price for her co-pay, and she had paid it in cash. The former billing company was unable to get the practice reimbursed from the insurance company, because of errors that were the billing company's fault. 

They sent this lady to collections for the total amount of the bill. This lady was in tears as she explained to me that she had an income of less than $1500/month and that her only expense that she could change was her food. She figured that she could skip her already meager meals every other day so that she could pay her bill over time. She had been a patient for 8 years and had never tried to not pay her bill before. - I was happy to fix this for her. She did not owe the practice any more money. I corrected the claim and re-billed the insurance company. My client was reimbursed from the insurance company the full amount expected. 

Imagine that this was your grandmother. This is the kind of incidence that is unnecessary and heart breaking. Unfortunately, this situation occurs too often and can severely damage perceptions of a practice. 

We work with your practice to establish guidelines as to how your practice would like to handle sensitive situations. As problem solvers we can correct situations like this and get your practice back in good-standing with your patients and your community.