Does Your Healthcare Billing Consultant Recommend these Best Practices?

Here are ten simple things to check on that will help you compare your physician billing procedures to “benchmarks:

  • Does your staff track your charge tickets to make sure they are all accounted for?  Do they use your scheduling software to do this?  If not, you may not be billing for each patient you see.
  • Is your fee schedule consistent for all types of patients?  Some practices only charge Medicare patients the Medicare allowable amount.  But Medicare pays its allowable amount, or the amount you bill, whichever is lower.  If your staff doesn’t keep the fee schedule updated, you may be losing collectable dollars!
  • Does your staff collect copayments at the time of the visit?  Copayments may be 10-25% of what you can expect to collect for an office visit.  Patients are required to make their copayments at the time of the visit.  If they do not, You may be spending $10 or $15 in staff time to track and collect that $5 or $10 or $15 copayment after the visit.
  • Does someone maintain an up-to-date insurance contract book, so payments from insurance companies can be verified against the contract rate or the contract fee schedule?
  • Does your staff follow-up timely on unpaid or underpaid claims.  Many insurance company contracts require you to submit claims within 30 or 45 days from the date of service.  If your original claim is not received, you can get denials for untimely filing – and lose out on revenue.
  • Are you keeping your fee schedule updated at least every twelve months so you are not billing any less than the amounts insurance companies or Medicare are paying?
  • Is your fee schedule based on a published relative value scale, with a dollar amount per RVU, or do you use a multiple of Medicare allowable rates for your geographic area.  This is a good way to make sure you are not billing at less than the Medicare allowable.
  • Does your staff follow-up on past due claims each month?  Do they document this in your billing system?  Many modern billing and accounts receivable systems allow for a virtually paperless billing office, including “ticklers” and reminders on who to call and when.  Is your staff taking advantage of these features?
  • Do you receive regular, such as monthly, A/R aging and similar reports? Do these reports make sense? Have you considered the benefits of a medical group practice billing consultant to analyze and review the processes and procedures used in your billing department? Good reporting and periodic “check ups” will make your billing and collection activities consistently perform well.
  • Finally, if you use an outside billing service, are they part of your tracking system, do their procedures include the ones just mentioned, and do they give you timely, understandable reports so that you can keep track of how they are doing?  Some outside billing services are shoestring operations that respond to the latest “squeaky wheel” client – so be sure to be squeaky – often!

Medical group practice billing consultants can help you get a detailed assessment of your billing department.  To learn more about how you can improve your bottom line watch the short presentation on how to improve physician billing processes.

So if you are considering using healthcare billing consulting services, look for someone who can ask the right questions and give you solid recommendations you can implement in your practice!

When you need proven expertise and performance

Jim Hook, MPH

Mr. James D. Hook has over 30 years of healthcare executive management and consulting experience in medical groups, hospitals, IPA’s, MSO’s, and other healthcare organizations.

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2 thoughts on “Does Your Healthcare Billing Consultant Recommend these Best Practices?

  1. I must say these best practices are spot on. I think I would like to mention that we are a collection agency that recommends that practices consider transfering patients to us at 60 or 90 days.


    1. Doctors are the last to get paid.

    2. Early intervention gets results.

    3. A diplomatic approach has worked for 41 years with us.

    4. A flat fee that averages $10.00 per account is better than the 30-50% standard agencies charge.

    Practices spend $7-$12 to send out one statement.

    5. Most agencies do not recover 20-30% of the money as they skim and work larger accounts as a rule. We don’t skim. We are blind to debt size.

    I guess the point is even billing companies are having dificulties collecting money from patients.

    What really changes when a statement is sent out at 120,150,180 days etc?

  2. Thanks, Charles! It has been a real challenge for many practices to find reliable collection agency services that are reasonably priced. We do see more of the flat fee approach, which is helpful to the practice.