Billing Network – Commitment & Accountability For Medical Billing, Part I

by Erez Lirov

Recently I had a conversation with a potential client concerning his trepidations about joining Billing Precision, a Billing Network. He mentioned that he spoke with several clients that were ecstatic about the service, but he wanted to know what the negatives were. In other words, what did clients who did not have a perfect experience with a Billing Network 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 traditional medical 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 a Billing Network 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 the Billing Network 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 the Billing Network identify the core problems and improve its processes so that others do not have to trip over the same land mines.

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:

1. He has made the decision to join the Billing Network
2. The transition will be difficult for everyone
3. He expects 100% staff cooperation and commitment
4. Anyone who can’t commit to delivering 100% should leave now

Very simple and very effective. The office was up and running in 3 days and was able to fully benefit from the Billing Network within 3 weeks.

In Part II, we explore accountability, reconciliation responsibilities, and support protocols, and we discuss how Billing Networks differ from traditional billing services in these respects.

Read more about the Billing Network’s “Network Effect.”