The Hidden Costs of “Economical” Billing Solutions

In today’s evolving renal health care landscape, especially in the aftermath of COVID-19, financial prudence when running a practice or dialysis program has become paramount. With operational costs skyrocketing and reimbursements from Medicare and other insurers struggling to keep pace, it is imperative for these health care entities to tighten their belts and avoid unnecessary expenditures to stay afloat. However, the choice of a billing solution, often made under the guise of cost savings, requires a thoughtful approach.

During a recent interaction at a health care conference, I encountered a nephrology provider engaged with a billing service that exemplified cost-cutting pitfalls. The provider was initially drawn to the service for its seemingly low fees, yet these fees only covered basic claim filing. Any additional billing services demanded extra charges, placing the provider in a dilemma: either hire additional staff for comprehensive revenue cycle management or contract yet another company for these services. This approach, appearing cost-effective on the surface, ironically led to higher overall expenses compared with billing companies offering full-service revenue cycle management.

This scenario highlights an important consideration for anyone considering an inexpensive billing solution: lower-cost billing services might not have the same level of expertise or resources as more expensive options. This can lead to inaccuracies in billing and claim processing, resulting in denied or underpaid claims. Efficient and accurate claim processing is critical for maintaining steady cash flow and reducing the time and resources spent on reworking claims. Likewise, billing services that charge lower fees often do so by minimizing the effort they put into each account. This might mean less follow-up on unpaid claims or less aggressive pursuit of denials, adversely affecting your practice’s collections.

Opting for more affordable billing services may also come with a trade-off in the form of reduced customer support. This limitation can become a significant source of frustration, particularly when unexpected issues crop up. Having access to knowledgeable and responsive customer service is crucial for resolving issues promptly. If billing errors occur or if patients receive incorrect statements, it can lead to dissatisfaction and complaints, potentially harming the reputation of your practice.

Medical billing services vary widely in their pricing structures. Some charge per claim or treatment, seemingly less expensive than companies charging a percentage of collections. However, this model can lead to reduced incentive for diligent collection efforts, as their revenue isn’t directly tied to the success of collections.

A trend observed in the electronic health records (EHR) domain is the integration of billing modules. While EHR firms boast benefits like seamless integration and built-in data checks, their primary expertise remains in technology, not billing. This technological focus often results in billing modules that are cumbersome and inefficient, consuming more time per claim, ultimately reducing the capacity to manage the broader spectrum of outstanding claims or conduct proactive financial analyses.

Moreover, these EHR-integrated billing solutions may falter in addressing the unique billing intricacies specific to nephrology, which can differ significantly from general physician office billing requirements. Many EHR billing combinations, while adept for basic billing tasks, may struggle with the specialized demands of renal care.

To safeguard your nephrology practice’s financial interests, due diligence in selecting a billing partner is essential. Engage with existing clients of your prospective billing services to gain insights into their performance and any unforeseen costs. Consider employing an external auditor to annually review your billing, ensuring both efficacy and compliance.

In conclusion, while fiscal efficiency is undeniably crucial for nephrology practices and dialysis programs, the selection of a billing partner should be guided by comprehensive service evaluation rather than mere cost considerations. The allure of “cheap” billing solutions can be misleading, potentially leading to higher costs and reduced revenue. Practices must critically assess the full spectrum of services offered, understanding that slightly higher costs might translate into increased revenue and efficiency. By adopting this holistic view, nephrology practices can ensure their financial stability while continuing to deliver high-quality patient care in an increasingly complex healthcare environment.

Sarah Tolson is the director of operations for Sceptre Management Solutions, Inc., a company specializing in billing for outpatient ESRD dialysis programs, nephrology practices, and interventional nephrology. Your questions are welcome, and she can be reached at stolson@sceptremanagement.com, 801.775.8010, or via Sceptre’s website, www.sceptremanagement.com.