Improve Reimbursements

Why outsource your billing? The smart approach is to maximize revenues and control and minimize costs and work. An in-house billing operation has little control and high costs. It is unable to identify and solve billing problems proactively. Think process, technology, and personnel. MAKE MORE MONEY!


  1. Reporting: Do you control billing yourself or do you rely on the opinion of your biller? Are your reports online or on paper? How easy is it for you to get the reports? Do you have to ask for them and then wait for delivery? How long do you need to wait to see a denials report or distribution of your payments for a particular CPT code by different payers? How often do you review billing reports? Can you tell the percentage of underpayment for every CPT code and for every payer? Can you predict mid-month about potential payment problems down the road? Can you figure out precisely the individual contribution of each referring physician and how it would be affected if you decided to cancel your contract with any one of your current payers?
  2. Measurement: Do reports have the detail required to assess quality of billing? How do you measure billing quality? What is your AR beyond 120 days? How does it compare with the national average? Do you know how much you do not collect? Is data available to you continuously and in arbitrary aggregations so that you can exercise control?
  3. Accountability: How do you know that every problem was resolved? Do you have a daily or weekly report of all the appointments that did not have claims, or all claims that required your attention and still wait for your response, or all claims that were submitted but not received by the payer, or claims that were received by the payer but not paid in the past 25 days? How do you communicate with your biller? Using yellow "Post it" notes and faxes? How do you know that none of them were lost?


How often does your office biller participate in coding/billing conferences? What happens if your biller becomes unavailable? What are the real costs of managing your own personnel, including hiring, training, benefits, vacations, sick days, your own time spent on resolving personality conflicts and following up on problems left behind because of their lack of knowledge?


Does it do everything you need and is it managed according to industry standards?

  1. Functionality: Does it have built-in reconciliation and workflow management to keep everybody accountable and to be proactive? Do you keep individual history of every action performed on every claim by everyone that has ever touched it? Does it integrate entire office workflow? Does it have built-in scheduler, notes, superbill, and personal workbench? Do you upgrade its LMRP and CCI knowledge base on time? Does it manage your fee schedule and does it alert you about its violations?
  2. Maintenance: How often do you perform backups of your system? When was the last time you tried to recover your data from your backups? What about software upgrades? Do you really want to be in the business of maintaining your own software and hardware?