What is the true cost of a low billing rate?

Your practice has a workflow process set up to ensure you are processing and reading each service for every patient.  You are confident that there aren’t any patients slipping through the cracks.  One of the ways this happens is due to the alerts set up in the hospital systems.  If something doesn’t make it to your workflow, there is another person tracking down what happened.  This allows the loop to be closed ensuring the patient and referring physician received the excellent care your practice provides every day.

After you sign off on your report, do you have confidence that you will be paid for it?

Will it even be billed?

These are important questions to be asking your billing department or outside billing service.  While you perform your work diligently and provide excellent care, there may be, on occasion depending on the patient’s financial situation and established policies, specific circumstances where you provide a service without being paid.  Unfortunately, all too often there are large cracks and a portion of the work you do is not getting billed.

There are various reasons for the billing of procedures to be delayed.

• The information was not sent to billing
• There is missing or incomplete information preventing billing from occurring
• A problem in the electronic data feed occurs
• A billing system or EHR issue occurs

All these reasons may occur, but there is no excuse for even one of your reports not to be accounted for in the billing cycle.

What happens if there is missing information?

A key step in the Revenue Cycle Management (RCM) process is validating every report from every patient has been received by the billing department or billing service.  This is a vital workflow process that must be in place to ensure all the work you performed is accounted for and billed accordingly.  If this step is not in place, you will be providing some of your services for free without you even knowing.

3 steps that should be taken in billing to provide your practice confidence:

1. Monitoring of data feeds received by your billing department or billing service including relative volumes expected.
2. Monitoring during coding that the volume is consistent between actual volumes received and relative expected volumes for the same period of time.
3. Monthly reconciliation for each facility you serve, comparing a reconciliation from the facility to the billing system.

The best process is to have a separate, independent resource that will provide a report of all the patients and procedures performed.  This report needs to be validated against all billed charges.  If there are discrepancies identified, then those discrepancies should follow an established workflow process to track down every patient and finalized report to ensure it is processed appropriately.

Your billing service or department must ensure they are capturing every finalized report your practice completes.  Even leaving one report per day unaccounted for can add up fast and hit your wallet hard.  You may think you have a great billing rate but if you add in the missing reports that were never billed, think again! You likely have a poor billing rate.  Don’t allow the initial, low billing rate to captivate your attention where you miss the opportunities to earn more (that’s legitimately your money).  You might be surprised to learn what the reduced rate will ultimately cost you.