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15 Questions to Self Assess Your Medical Billing

Posted on December 10, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Care360 has put out a great little whitepaper that looks at outsourcing your medical billing. In the whitepaper, they talk about various aspects of doing your medical billing in house or outsourced including: control, communication, cost, performance, and management style.

This is all great, but I find that many practices are still trying to figure out whether they should spend time considering outsourced medical billing or not. So, the best part of the whitepaper for me was these 15 questions that provide a good self assessment of a practice’s medical billing:

Medical Billing Self Assessment

Remember that answering yes doesn’t mean you should outsource your billing. For example, if on question #13 you say you are looking to expand your practice, then that might be a reason not to outsource your billing. From my experience medical billing generally benefits from scale. So, if you’re planning to grow your practice large enough, it might make since to keep your billing staff in house if you can grow it large enough to enjoy the benefits of scale.

There are a lot more details on outsourced medical billing in the whitepaper. I’m seeing more and more organizations outsourcing their billing as it’s become more complex. These questions provide a good framework for you to consider your current approach and how you could benefit or suffer if you outsourced your billing.

What Happens When Billing Is Optimized?

Posted on May 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my recent EHR workshop in Dubai I talked with them about the many changing EHR business models that I’ve seen over the last 10 years. I was really trying to highlight how these new business models have generally been good for healthcare since it’s caused EHR prices to drop to a much more reasonable price point.

Take for example the Free EHR model. Whether you love it or hate it, one thing is certain: Free EHR has caused all the other EHR vendors to lower their price. I’ve seen this over and over again with EHR vendors. It’s hard to compete with an overpriced product against free. So, they had to lower their price so that the price of their EHR didn’t look as bad against free.

One model that I mentioned to those who attended my workshop was that some EHR vendors charge a percentage of billing in order to use their EHR software. athenahealth is the most famous for this approach. Their business model has worked pretty well for them because they’re able to say that not only will the practice get the EHR software for free, but athenahealth also can make the case that by having them assist with the practices billing, then they can help to better optimize the practices billing as well. So, the practice is getting more effective billing and a free EHR. This is why athenahealth could charge such a high percentage of an organization’s billing.

Turns out that there are a lot of billing companies that make a similar business case. Pay me 4-6% of your billing and we’ll optimize your billing which will actually make you more money than you’re paying us. Most of the billing management companies work off of this approach. Of course, this approach works best when you’re talking about practices that aren’t doing a good job managing their billing. This actually seems to apply to most practices.

What I’ve started to wonder is what’s going to happen once all of these practices’ billing is basically optimized? Now the percentage of billing starts to feel really expensive. Practices won’t be good at realizing the optimization that’s occurred and I’m sure that many will choose to take on the billing again. As they take on the billing, they’ll head back to a less than optimized state and then they’ll be ripe pickings for a billing company again.

I can see this cycle happening over and over again. Plus, if you’re a billing company or a company like athenahealth that makes your money off of a percentage of billing, then there’s always new practices that are at every stage of the cycle. So, there’s new business all over the place. The key for these organizations is to find the practices that are at the right place in the cycle.

Will anything happen to stop this cycle?

Patient Billing Experience is Tied to HCAHP Scores

Posted on October 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I first heard about this earlier this year when I met with ZirMed at ANI. Since then, I keep hearing this concept over and over and so it’s finally time for me to create a blog post on the topic. How you bill a patient has a tremendous impact on patient satisfaction and therefore your HCAHP scores.

When you read that, I’m sure you’re thinking “Well duh! Of course it does.” While it’s obvious once it’s stated, I don’t know many organizations that are working to improve their HCAHP scores by improving their patient billing processes. I have seen a lot of programs that look at the patient experience getting checked in, while their in the hospital, and how their discharge goes. Unfortunately, many organizations seem to stop one step short of the finish line. It’s like running 25 miles of a 26 mile marathon. The patient bill is the last mile of that journey.

The final experience a patient has with a hospital is usually when they get the bill from the hospital. There are so many ways this can be a terrible experience for the patient. If the charges are a lot more than what the patient expects, they’ll have a bad experience. If it’s not clear what charges they owe and whether insurance has paid their portion or not, they’ll have a bad experience. If they see the $5 aspirin (yes, that’s representative of charges that don’t make logical sense to the average patient), then it can damage their experience. If there’s no way to pay the bill online, it can leave a bad taste in the mouth for many. If it’s not clear what the bill is charging for, it can cause a bad experience. I could go on, but you get the idea.

All of these issues (and no doubt there are plenty more) have no impact on the care the patient received. In fact, your doctors and nurses could have provided an amazing customer service and literally worked miracles to save the patients life. However, if the billing experience is bad, it can leave a bad taste in their mouth and that will show up when they’re rating your hospital.

No doubt there are plenty of edge cases that we’ll never be able to satisfy. However, there’s a lot more we can do with our medical billing processes to ensure that the experience is a lot better than what it is today. Your HCAHP scores shouldn’t suffer because you didn’t take the time to make your billing process as beautiful as your clinical care.

Practice Fusion Announces 3 Billing Partners

Posted on May 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With the news of Mitochon shutting down their Free EHR business, that really only leaves a couple players left in the Free EHR space. The largest one is Practice Fusion, but it has challenges of its own. You might remember the announcement that Kareo bought the Epocrates EHR and is offering the EHR for free.

You could tell that Practice Fusion was put in a bad position when Kareo decided to basically part ways and offer a competitive product to Practice Fusion. Although, no doubt Practice Fusion and Kareo both knew it was going to happen sooner or later. The key question was how Practice Fusion was going to respond to the move by Kareo since Practice Fusion was sorely lacking in the billing department.

Well, the answer is now in. Practice Fusion just announced 3 preferred billing partners: NueMD, CollaborateMD and ADP AdvancedMD. You can see NueMD’s press release about the partnership here. Both NueMD and CollaborateMD are offering their billing solution starting at $149/month. ADP AdvancedMD offers “customized pricing” which means they don’t want to commit to a price and likely change the price based on the size of the practice.

The Practice Fusion announcement I got did say that these integrations will happen “later this summer.”

It’s an interesting choice on Practice Fusion’s part to continue down the integration road versus developing their own billing software or just buying one of the billing software that’s out there. I wonder if this is going to pose a long term problem for them. I wonder if Practice Fusion learned from the Kareo experience and the contracts with NueMD, CollaborateMD, and ADP AdvancedMD take this into account.

No doubt Practice Fusion comes at the EHR world with a different business model in mind, but it could be a mistake for them to not also have a hand in the purse strings (billing). Sure, they’ll get some short term financial bump from these three partnerships, but are they trading revenue for long term connections with the doctors?

Our Perception of Physician’s Pay and Understanding Medical Billing

Posted on June 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently saw a Freakonomics article being passed around Twitter that I couldn’t resist reading. Here’s a link to the article that’s titled “What Surgeons Get Paid, and What Patients Think Surgeons Get Paid.” Here’s a section of this article:

On average, patients thought that surgeons should receive $18,501 for total hip replacements, and $16,822 for total knee replacements. Patients estimated actual Medicare reimbursement to be $11,151 for total hip replacements and $8,902 for total knee replacements. Seventy per cent of patients stated that Medicare reimbursement was “much lower” than what it should be, and only 1% felt that it was higher than it should be.

In reality, surgeons get paid on average $1,378 for a total hip and $1,430 for a total knee. Thus patients were off by an order of magnitude in their estimates! The disconnect in public knowledge seems extreme.

In short, patients — the most important part of all of health care policy decisions — have absolutely no clue how much doctors get paid. They think we get paid (or, at least, deserve to) about 10 times more than we actually do!

I know this is a touchy subject, but when have we ever shied away from something touchy?

I think there’s a huge flaw in the above commentary. They should have asked the patients what the patients thought a physician’s annual salary was as opposed to what they should receive for a specific procedure. I think if they did we’d have seen very different results. I have a feeling that if they’d asked this way, the public would have probably been under for specialists like surgeons and would be over in what they think primary care doctors get paid.

The challenge doctors face is that almost no one in the public is going to feel bad for doctors that only get paid $100k per year. Maybe there are reasons they should, but it’s not going to happen. Plus, many doctors don’t help the situation when they drive around their Mercedes and BMWs.

Although, the more important point I take from the above commentary isn’t about physician’s salaries. Most physicians I know would love to get paid more, but they’re all doing fine financially. The larger point in the above excerpt is how clueless patients are at knowing the price of medical care.

I’m sure there are a number of factors at work here. Not the least of which is many patients who don’t care. The complex medical bills and insurance reports don’t help either. I’ve heard some hospital execs admit that they made the medical bills complex to read and understand because they didn’t want patients to know that the aspirin charge (or insert other item) was $5 (or some other outrageous amount).

If patients are going to start being active participants in their healthcare in order to lower healthcare costs, one good place to start might be the medical bill. The above example shows that patients are clueless as to what their healthcare is costing them. A clear medical bill could be the first step to helping patients become less clueless and more active participants in their medical care.