Tips for Selecting a Medical Billing Solution

From the Field 

One commonality between most dialysis programs and nephrology practices is that both must submit claims to insurance companies to collect reimbursement for services provided. The three most common billing solutions I have encountered are an in-house billing team, EHR company billing, and third-party billing services. I have observed pros and cons of each in my 14 years in the renal billing industry. In this issue, we will examine the challenges and benefits of these billing solutions to consider when choosing a billing solution for a nephrology office or dialysis program.

In-House Billing Team

Having an in-house biller or billing department is likely the most popular solution. Most of the people I work with at Sceptre Management have experience working in a medical office as an in-house biller or billing department manager. Having someone in your office managing the revenue cycle and collecting on outstanding accounts receivables can be convenient because you’re able to interact with them daily, and they understand internal processes and can handle other duties.

However, it can be a challenge to cover time an in-house biller is unable to work, such as vacation and sick time. It is not a role that is easy to cover, as it can require at least several months of training. While some practices are fortunate to have long-term billers on their payroll, many practices and dialysis programs are plagued by turnover in their billing staff. Hiring new billers often results in a slowdown in billing and collections while the new hire is trained. My experience has been that it usually takes a minimum of 6 months for billers to have a basic understanding of dialysis billing and reimbursement. Having to hire a new biller frequently can really put a strain on cash flow.

EHR Company Billing

With this solution, maintaining clinical and patient demographic data in the same system is convenient and efficient when the work performed each day is automatically converted into billing data. If the EHR company’s billing department performs well, this may be a good option for a practice that prioritizes consolidating their vendors.

When considering this solution, think about the following:

• How much experience does the EHR’s billing team have with your specialty?
• What options do you have if you love the EHR but aren’t happy with the billing services?
• Will the EHR let you bring your billing in-house if you aren’t satisfied with their performance or would they require you to switch to a different EHR?
• What are the checks and balances in place to assist you in monitoring the performance of the billing services?

Third-Party Billing Service

Third party billing services vary; some require you to use their EHR, while others are EHR agnostic. Some break tasks up into accounts receivables, charge entry, and payment posting teams, or may assign specific representatives that only work on your account.

Working with a reputable third-party billing service that specializes in your practice specialty may help your reimbursement to be better optimized due to the service’s in-depth knowledge of that specialty’s billing requirements. Working with a third-party billing service helps to alleviate the turnover and headache related to training billing staff.

While third-party solutions can be a great option, keep the following in mind when considering it:

• How will they charge you based on what is collected or what has been billed out?
• Will they invoice your practice at an all-inclusive rate or are there separate charges for things such as submitting secondary claims, sending appeals, or mailing patient statements?
• How often does the billing service meet with you to review your practice’s accounts receivables?
• What access will you have to the billing data?

Once you decide on the billing solution that seems like the best fit for your practice, it may be beneficial to interview several different companies or individual billers. After identifying those that seem like good fits, it can be helpful to check their references as well.

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.