At one time billing might have been one of those mundane jobs in a medical practice – but not so anymore. Between automation, outsourcing and healthcare overhauls, the medical billing industry is going through a period of rapid change and seeing the rise of billing giants like Athenahealth, eClinicalWorks and McKesson.
We recently asked several smaller billing companies what they were doing to stay viable in the face of these competitors, here’s what they had to say:
What is your strategy for competing with major players like Athenahealth, eClinicalWorks and McKesson?
“We believe in keeping it simple. We believe in being focused.
Focusing on the efficiency of any business is the key to getting the most out of lean, and ultimately improving our service and client satisfaction.
Although these larger players have an array of services, some better than others, simplicity gets lost, ultimately leading to increased physician expenses.
Smaller businesses with the right combination of people can be more agile and flexible.
It all starts with the managed care contract, without question, we are efficient and effective – while keeping it simple.”
– Dana R. Bellefountaine Jr., president and CEO of CodeToolz, is a senior C-level executive with over 20 years of experience in Healthcare Finance and Accounting with medical practices ranging from single-physician startups to multi-physician, multi-specialty facilities. He has a considerable background in reimbursement methodologies and financial analysis and understands the current and emerging challenges that face the healthcare providers and partners with clients to address these issues and create opportunities.
When it comes to out-of-network medical billing, there is only so much that software, data analytics and coding knowledge can accomplish.
Much of what we know and what we do is not taught by any medical billing, coding or certification course. It is information learned through intense follow up and investigation on claims processing.
At the end of the day, it takes an actual person on the phone who is able to navigate through the various internal edits, third-party pricing companies, third-party medical review companies and overpayment auditors, to get a claim properly paid. The major players are typically not set up to provide this kind of service.
Any problems beyond a second submission or second inquiry on a claim are not cost effective for them to pursue. It is not unusual for a complex follow-up phone call on a stuck out-of-network claim to take anywhere from one to three hours, and this would put major players in the red when it comes to the hourly productivity of their employees.
Additionally, we do not require or limit ourselves to one type of billing software. Our clients can keep their existing EMR or PM, which we work out of, or, we can recommend or provide software for them.
– Matt Dallmann is a Co-Founder of New York City’s VGA Billing Services, and specializes in out-of-network medical billing.
“We have learned the value of having access to electronic health records used in our clients’ offices. We get current insurance and demographic information as well as authorizations and reports used for billing. Many EHRs include a billing module. In some cases the EHR is free to the practice if the EHR company does the billing, keeping a percentage of revenue.
The competitive edge we offer is our proven billing expertise and track record with long-standing clients in addition to focused responsiveness to their needs. We stay competitive because we use EHRs as tools rather than threats to our business.”
– Since 1988, Bob Liepman has owned Documed Medical Billing Services, which manages the entire revenue cycle for clients in the medical and behavioral health professions.
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Last Updated on August 9, 2022
It definitely makes sense how it’d be best to have an actual person work on all the internal edits, third-party pricing companies, third-party medical review companies and over-payment auditors in order to make sure it is done correctly. I know that if I will receive billing for my healthcare I feel that you can trust a person better if you have some circumstances that make the billing process a bit different from the norm since a computer would only be able to bill one way. It’d be good to find a company that works solely with billing for the healthcare field since they would be able to use both the automated billing and in-person billing to make sure it’s all done correctly and no one is overcharged.