Billing is a full-time job that most practices staff part-time, and it is unforgiving
of the gaps. It requires attention to detail, compliance with rules that change, and
somebody watching payer requirements continuously. Practices that find themselves
overwhelmed by it usually do not have a people problem — they have a structural one.
The case for handing it over
It is a specialism, and specialisms compound
A billing company does coding, submission and claims work all day, across many
practices and many payers. That produces pattern recognition your own staff cannot
acquire on your volume alone — which denial reasons cluster with which carriers, and
which of a payer’s stated rules are actually enforced.
The overhead is larger than the salary line
An in-house billing function costs more than the person doing it. Hiring, training,
supervision, cover for leave, software, hardware, forms and postage, systems upgrades,
and the cost of the errors nobody catches. Outsourcing removes most of that, and —
more usefully — converts a fixed cost into a variable one that moves with your
collections.
Cash arrives sooner
Timely filing and efficient claims processing shorten the gap between doing the work
and being paid for it. Since the odds of collecting fall as an account ages, speed is
not just a convenience — it is a collection rate.
It scales in both directions
Adding a provider does not mean hiring and training another biller. A quiet quarter
does not mean carrying capacity you are not using.
Compliance stops being a side project
HIPAA obligations and data security are core to a billing company’s operation rather
than one of nine things a practice manager is responsible for.
How to choose — including where we would currently fail
This is the more useful half, and most articles like this skip it. If you are
evaluating billing companies, these are the questions worth asking. We have marked
the one we cannot yet answer well.
-
How are you paid? Hourly and flat-fee billers are paid whether the
claim is approved or denied, and paid again to fix it. A percentage-of-collections
model puts the cost of rework on the biller. Ask which one you are being quoted, and
ask what happens financially when a claim is denied. -
Where is the work physically performed? Many large firms route
claims work offshore. Ask directly, ask which country, and ask what compliance
standards apply there. An attractive rate is sometimes an offshore rate wearing a
domestic name. -
Who, by name, works my account? If the answer is a team or a
department, ask what happens when you have a question about a specific claim. -
Do I keep my data, and what does leaving cost? Ask for the
termination clause before signing. You want a full export at no charge and
no hostage period on the database. This question tells you more about a vendor than
any other. -
What reporting do I get, and can I run it myself? You should have
your own login. A billing company that makes you request your own numbers has told
you something about the relationship. -
Do I have to change practice management software? Sometimes the
honest answer is yes, but it should be a separate decision and separately priced —
not bundled into the billing agreement as a condition. -
Experience and track record. Here is where RevAmp currently fails:
we are a new firm and we have no client history to show you. If an established
reference list is your deciding criterion, we will not meet it this year, and we
would rather say that here than have you discover it three calls in. What we offer
instead is a fee model where we are not paid unless you are, and a free A/R audit
that costs you an aging report and ten minutes.
The honest summary
Outsourcing billing is not primarily a cost-saving measure, and any vendor selling it
purely that way is skipping the interesting part. It is a decision about where a
specialised, continuously-changing function should live, and whether the people doing
it are paid in a way that aligns with you getting paid.
If you want to test the arithmetic before you speak to anyone — us included — the
four calculators are ungated and store nothing. Take
the numbers to whichever firm you are talking to.