Is the business of medicine really different than any other business? Yes, there are ever-changing rules, regulations, and guidelines. Medical research goes on in the labs, trying to find ways to control or cure conditions and diseases from A to Z, all the while inundating us with new drugs. Much to learn, what with overlapping usage, conflicting contraindications and side effects, all courtesy of the pharmaceutical companies, who, by the way, have no trouble turning a profit.
Today’s healthcare providers have more than ever, with which to stay informed. People living longer present a whole new level of care, between preventative, diagnostic, and therapeutic, for doctors to be familiar with. Of course, we can’t forget OSHA, HIPAA, and the government trying to lower Medicare rates year after year, only to meet such opposition within the medical community, that the exorbitant decreases have yet to be approved.
Going back to the original question, no, medicine is not different than any other business. Our product is different, our customer is a patient, but the objective, in the business sense, is to make money. How and when is the doctor able to tend to the business matters at hand with so many other responsibilities? How can he keep up with the continued changes in medical coding, insurance plans, medical necessity guidelines, referrals, just to name a few? More often than not, he can’t!
The business of medicine is still a business, but due to the complexities aforementioned, it requires skilled individuals with very specific backgrounds, both in business and healthcare, to maximize the reason for any business; making money. Unfortunately, a very important part of the medical practice, the business itself, is often left to inexperienced, unmotivated, inefficient individuals, whose main concern is not necessarily the bottom line. Usually, by the time this situation is discovered, the cash flow has already been affected.
The billing department is such a critical component of the medical practice, but is regarded as routine or easy, in many cases. The only time it is easy is when the people responsible for getting the money into the practice are on top of every detail. Short of that, it is not got to be as successful of a business as it can be. Period!
If “good enough” is good enough, then when collections are not maximized and the A/R is not truly clean, it doesn’t matter. If every claim is not coded properly, filed in a timely fashion and ultimately needs to be written off, it doesn’t matter. The kiss of death, in every medical office, are the denials not being worked and just piling up. Every denial is an unpaid claim. But, maybe this doesn’t matter either.
Some doctors think if they keep billing “in house” with their own employees, they have more control, pay less money, see what’s going on. In reality, the majority of employees today just want their time off and their paychecks; the least amount of work for the most benefit. That is not news.
Outsourcing is becoming popular in many businesses today for various reasons. The employer does not have to provide benefits, such as vacation pay, health insurance, 401 Ks, etc. and is not responsible for payroll taxes or workers compensation coverage. When work is outsourced or done by a sub-contractor, they are, in a sense, running their own business, so the level of conscientiousness is higher. They are there to do the work, not hang around until 5:00, just because they are being paid to do so.
My partner and I have been in the business of healthcare for 20 years and work strictly as sub-contractors. Between us, our education is in business management, our experience is in medical billing, management, and coding. Strong communication skills, attention to detail, and high work ethics propel us to be extremely successful. Whether full billing services from charge entry to claim settlement, or specific A/R recovery projects, diligence and dedication help us achieve excellence.
We are provider advocates and go to bat with the insurance companies on the most difficult claims that many other people write off as a lost cause. To us, it becomes a challenge and we go after it that much harder, with full determination. Whether they give in because they are sick of us on the other end of the phone, we will never know. When a paid claim is the end result, that’s all we care about. Our motto is, if the patient is covered by an insurance policy (and there is no eligibility issue) the claim needs to be paid.
To recap, it takes true professionals to run the most important department in your practice, billing. Yes, it is about experience, but it is also about energy and motivation. Skills can be taught if the drive is there, if it isn’t, not so much.
