As you've built your practice, you've signed on with a growing list of insurance plans, including Medicaid and Medicare. But managing this part of the job is getting ever more unwieldy. You feel as torn as Shakespeare's Hamlet as you ponder whether or not to hire a billing specialist.
Let's examine the possibilities for billing processes:
- Submit your own claims. I have seen insurance claim submission go from paper to electronic over my 10 years in private practice. Today you can usually submit claims through (typically free) portals on insurance providers' websites or through a one-stop clearinghouse housed on one website. The obvious advantage of billing insurance claims on your own is that you will understand the "ins and outs" of how insurance claims are processed and paid. This knowledge is valuable. You will save money by not having to pay someone else to prepare and submit claims. The main drawback to taking on this continually changing task is that you may limit your practice's growth and development. During this time, you may not be able to grow fully as a supervisor, community supporter and clinician. Your focus will be divided between insurance matters and treatment matters. If you find it is costing more to bill on your own and stay abreast of constant insurance-billing changes, it's time to delegate.
- Hire a company specializing in medical billing. All medical claims companies are not the same, especially with increasing use of predetermined fee levels for a set number of patient visits, requiring providers to repeatedly re-apply for further visits (a topic for another day!). Many of these companies charge a certain amount per claim submission. They also may add on clerical services charges à la carte for services such as following up with insurance companies for denials, completing authorizations for services and checking eligibility (initially and monthly) for patients. The more services you add to the service contract, the more you pay monthly. These costs can add up, sometimes becoming more than your budget can handle.
- Hire an in-house billing specialist to handle all billing and treatment authorization. In this economy, plenty of clerical professionals with medical claim billing experience are seeking hourly positions. They not only can submit your claims, but also take the time to communicate with claim representatives and EDI (electronic data interchange) specialists. Your billing specialist also can attend webinars and networking events on your behalf to keep you abreast of changing policies affecting Medicaid, Medicare and private insurers. Having your own billing department frees you up to develop and oversee the myriad other facets of your practice. You can see your patients as patients, rather than worrying about their coverage.
- Use claim submission services built into electronic health record programs. Some of these services charge a nominal monthly fee. Others are free, but charge a percentage or set amount per claim submission. Some of these programs also offer follow-up and claim resubmission services if claims are denied.
My choice? An in-house billing specialist. She's knowledgeable and on top of the constantly shifting insurance claim submission and authorization landscape.
I highly recommend assessing your insurance claim billing needs. Set aside a specific amount of time to assess and re-assess any changes you make to your insurance billing protocol. This scrutiny will allow you to evaluate the success or lack of success of your insurance billing process and make further changes. Remember, change is good, but stability is better!