Posted by: AtlasMD

December 16, 2013

The Third Medical Billing Option — DIY

Practitioners always need to decide how they’re going to get paid. Of course, if you’re in the fee-for-service world, your payment is inextricably linked to billing codes. But the goal is same for any doctor — garner maximum revenues with minimal costs while not compromising the quality of services. Let’s for now assume you haven’t transitioned to direct care. Your first option would be in-house billing.

In-house Medical Billing

On average, in-house billing departments for a practice typically require two expert trained billers for every three providers. The cost of this in-house billing department will include salaries and the cost of hardware, software, and additional materials like courses, books, etc.

Let’s consider this for a moment. Your practice requires “trained professionals” to help you get paid. How complicated is fee-for-service billing? Why can’t a doctor do this themselves? Well, for one, let’s say that someone came in who claimed to be involved in a traffic accident. That should be easy, right? Look up “traffic accidents.” Well, yes and no. Actually your ICD-10 coding world would look more like this:

First, you’d come to Transport accidents (V01-V99). Take note that this section is structured in 12 groups. There are codes relating to land transport accidents (V01-V89) which reflect the victim’s mode of transport. These are then subdivided to identify the victim’s “counterpart” or the type of event. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important factor to identify for prevention purposes. Here are some emergent possibilities.

  • Accidents to persons engaged in the maintenance or repair of transport equipment or vehicle (not in motion) unless injured by another vehicle in motion (W00-X59)
  • Accidents involving vehicles, but unrelated to the hazards associated with the means of transportation, e.g., injuries received in a fight on board ship; transport vehicle involved in a cataclysm; finger crushed when shutting car door (W00-X59)
  • Assault by crashing of motor vehicle (Y03)
  • Event of undetermined intent (Y31-Y33)
  • Intentional self-harm (X81-X83)
  • Pedestrian injured in transport accident (V01-V09)

That’s just the beginning. You can have “pedestrian injured in collision with pedal cycle, “pedestrian injured in collision with two- or three-wheeled motor vehicle,” or “pedestrian injured in collision with car, pick-up truck or van…”

When is enough enough? While the motivation to create a system that clearly links government/insurance payment for services rendered is laudable, the reality is that it’s insane. At what point do we start to chart whether or not someone was assaulted with a smartphone versus a tablet? Can you imagine an insurance agent arguing that the phablet (those oversized smartphones) are technically not tablets and trying to forego a payment? It sounds nuts but this stuff happens every day. It’s all part of competing companies’ P & L. Insurance companies, as vital as they are in helping people through unexpected circumstance, are fighting to keep their money. Meanwhile, a fee-for-service doctor is fighting A) to keep his door open by seeing more patients because B) he has to hire people to help him collect money for his services rendered which means C) he creates more expenses leading him back to A) seeing more patients. It’s a vicious cycle. And there are many examples of companies that have failed to pursue account receivables due to budget constraints required to process those collectibles.

Outsourced Medical Billing

This is ideal for medical practitioners who don’t want to get caught up in hiring and training a separate billing department. It can save them a lot of cost since they won’t need to spend thousands of dollars on setup costs, administrative costs and overheads. Instead, they can pay a certain percentage of their monthly or annual collections to the billing companies who will solve all their hassles.

The problem here though is that since you aren’t billing yourself, mistakes can happen. And these can be costly. Usually, top-end medical billing companies will charge anywhere between 5 – 10% of your practice’s collections.

Direct Care & EMR

Alternatively, you can consider ditching the insurance companies and the codes which have made getting paid as a doctor a separate career entirely. Instead, what if you were able to spend time connecting with new and existing patients? What if you knew that the people you helped were the people who paid you? What if you could get paid as easily as you would for selling something on eBay or ordering a subscription on Amazon? What if this same tool that helped you get paid also served as a lean, efficient EMR? What if you only paid ~3% per transaction instead of 5-10% like you would when you have outsourced billing? What if you could have this software for a fraction of the cost of hiring an in-house billing team? Oh, and what if we told you you could try the software for a month, for free?

Sign up for EMR free for 30 days