Coding and Billing

Will Outsourcing Coding & Billing Help or Hurt Your Practice?

By Diane Palombi, OD

July 6, 2016

Third-party coding and billing services can be a great help to a busy office, but choose wisely to ensure the outsource partner you choose helps, rather than hinders,  your practice.

Your office is becoming extremely busy causing your staff to complain that they are overworked. Lo and behold, a company comes along willing to take care of your patient billing. Sounds great! Do you jump on board? You may want to think long and hard about it after reading this recent encounter that I experienced.

My husband and I are patients at the same family practice group which is owned by a major hospital in our area. The hospital does the billing for the doctor’s office. My husband had a few visits over the fall and early winter before we left for Florida. As usual, our insurance was billed first, and then we would be informed later of any out-of-pocket expenses. We then left for Florida for the winter. While there we received no bills, so we assumed that all was well with this account.

When we came back to Missouri in the spring, my husband had a routine follow-up visit scheduled. We then discovered that we still owed the practice for expenses incurred during his prior visits.

The doctor’s office had us contact their billing company for an explanation. It was a comedy of errors. The billing company had a prior address down in their system as our current address. Mind you, we moved from that address almost 20 years ago. Obviously, they did not bother to update our personal information from our doctor’s office. When they received the first bill back, they corrected their mistake, but did not bother to send out another bill. The bill from his next doctor visit was correctly sent to our Missouri home, but we were in Florida at that time.

This company does not allow their bills to be forwarded, so we again did not receive it. Instead of trying to contact us by phone or letter, they sent both bills to collections. My husband about had a heart attack on hearing this since his credit rating is very important to him. Fortunately, the employee meant their internal collection department, and not an outside agency, so his good credit remains intact. However, it is scary to see how potentially easy it can be to have a blemish on your credit report from a debt that you were not aware even existed.

It seems to me that this billing department is not too proactive about getting their doctors paid. Being a doctor myself, I do not like to let other doctors wait long for payment, so I pay my bills promptly. I felt bad that this doctor had to wait unnecessarily for months for my payment. I also do not want to appear as a deadbeat who does not pay my debts. However, there are people who like to work the system and string things along for as long as possible in order to hold onto their cash. In addition, the employee whom my husband spoke to on the phone had an indifferent attitude. He didn’t seem concerned about getting the bill to us and the doctor paid. The attitude of this billing department employee was that they have their system, so too bad that we fell through the cracks.

My practice handled its own billing. First, we took steps with the insurance companies to verify coverage and benefits before the patient came in for their exam. That way we knew exactly what the patient would be paying out of pocket. On the initial visit, at least half of the out-of-pocket costs were expected to be paid before their materials were ordered. We would then mark the balance on their lab tray label by their name and on their receipt inside the tray. The balance was to be paid when they picked up their contacts or glasses.

Because full out-of-pocket payment was expected before materials were released, I rarely had to send out bills to the patient’s home. However, when it did occur, I had a simple system. I sent out a copy of the initial bill with a friendly letter stating that the insurance paid its share and the amount they were responsible for paying. I included a stamped self-addressed envelope for their convenience.

Believe me: I think it was worth the price of a stamp since the majority of people paid us promptly. We never filed the patient record away until their balance was paid. Weekly we would check the balance due files to see if we had to send a second friendly reminder letter. If it had been several weeks since the initial letter we would again include the prepaid envelope. We did have a third letter, which fortunately did not have to be sent often, which threatened sending the bill to collections. My system worked for me because I had very little bad debt that had to be written off in my years of practice.

We became optometrists to help the public see better. But getting paid for our services is also very important since we also have staff and bills to pay. It is not advantageous to wait longer than necessary to get paid.

A third party does not always have your best interests at stake. You need to be proactive in managing your accounts receivable. If you do need to delegate your billing to an outsource partner, be diligent in making sure they are doing their job properly. You could be the best optometrist in the world, but you need to be properly compensated for it or you are out of business. Only you, personally, have a real vested interest in making that happen.

Do you use an outsource partner to process coding and billing in your office? How do you ensure patients are billed in a timely manner, and that you get paid?

Diane Palombi, OD, now retired, owned Palombi Vision Center in Wentzville, Mo. To contact her:

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