High Billing vs. Low Collections

WHY IS THIS A PROBLEM?

Your fees are set according to your skill and ability to help your patients, but the checks coming back from insurance companies are a fraction of the total amount you bill out. Why?

Often a healthcare practitioner will feel like there is an injustice occurring when they bill $40,000 and collect $20,000 from insurance. The fact of the matter is that the amount that remains unpaid may never have been collectible in the first place.  It’s a common confusion and it can be upsetting, but with a good concept of exactly how the insurance game works, you can be a better player in that game.

IS SOMETHING WRONG?

Not necessarily. You bill $100. You get $35. It may feel wrong, but there is more to it.  All insurance companies have their “allowed amounts”. This means that no matter what an office charges for a service, the insurance company has a cap on what will be paid.  Allowed amounts are the maximum that they will allow to be paid to a provider for a service, including copays or co-insurance percentages paid by a patient. Your professional fees are likely much higher – and you may collect that higher fee from cash patients, or Personal Injury and Worker’s Comp cases. But with regular insurance billing, you can bill out the services you deliver at your prices, and the insurance company will pay the set amounts that they are willing to pay.  You are not going to – ever – receive more than their allowed amounts on your insurance patients, and in fact, audits are common in order to confirm that insurance reporting is being done according to the rules.

While there are valid concerns about the need for insurance reform, this is simply stated here for the purpose of explaining the reasoning behind the caps. Accepting insurance can significantly increase the number of patients that are able to visit a practitioner. From the perspective of the insurance industry, the caps prevent practitioners from skyrocketing their prices, knowing that insurance companies would have to cover them. If that were to occur, the insurance industry could potentially no longer be able to cover patients. And without insurance coverage, those patients wouldn’t be able to afford to come to you for the care they need. Many practitioners feel undervalued by insurance companies, and rightly so, however if you are accepting insurance patients, this is how the game works. Understanding it well can help to make it work for you.

WHAT ABOUT BILLING ERRORS?

It is certainly true that there may be billing and coding errors clouding the issue and causing a lot of denied claims. Most of our clients have some of both occurring when we take over the billing – there is a billed amount that is higher than the allowed amounts, making it falsely appear that the collections % is lower – but there are also billing and coding errors which have gone uncorrected, causing denied claims and bringing collections down. As we go about correcting the errors and seeing that office procedures are updated to ensure that the same mistakes don’t continue to occur, we can help to significantly improve the bottom line.

SO, HOW DOES INSURANCE WORK?

Here is a simplified example:

Your fee for a chiropractic adjustment is $100.

ABZ Insurance Co. has $35 as their allowed amount for that same adjustment.

The patient has a $20 co-pay, which they pay directly to you.

You bill the insurance company, showing your fee of $100.

ABZ Insurance will send you $15.

$15 from ABZ + $20 from the patient co-pay = ABZ Insurance Company’s allowed amount of $35.

 

 

Here’s another simplified example:

You deliver four procedures to a patient in one visit. That $100 adjustment, plus adjustment in extremities, electric stimulation and massage. The total of your fees for the visit comes to $300.

The patient’s insurance company, XYZ Healthcare, has an allowed amount of $40 total per visit.

The patient has a $10 co-pay. Let’s say that your verification wasn’t completed at the time of the visit, so this did not get collected at the front desk, and you didn’t know that all those services delivered would not be reimbursed.

You send your bill for $300 to XYZ Healthecare.

XYZ factors in the co-pay that the patient owes you, and they cut you a check for $30.

It’s now up to you to bill the patient for the co-pay amount that hasn’t been collected.

$30 from XYZ, plus the $10 the patient owes = $40, XYZ Healthcare’s allowed amount per visit.

 

WHAT CAN YOU DO ABOUT IT?

This is where good insurance verification comes into play. To start, you can get the list of allowed amounts from each insurance company you are enrolled with so that you know what they will pay for your services. Then, contacting the insurance companies in advance of treatment to find out what your patient’s deductible, co-pay and coverage limits may be will help to ensure that your patient collections go smoothly, and that the procedures delivered will be paid for. We regularly help our client’s staff to understand and get prepared for thorough patient insurance verification, as an included part of our services. Verification is vital to the success of the billing process for all of us.

Billing vs. collections is a game of averages. The pieces include your professional fees, the insurance company’s allowed amounts, and the percentage of insured patients you see against the number of cash patients and Personal Injury or Worker’s Comp cases your office handles. Insurance enrollment puts a greater number of prospective patients within your reach – and puts your help within the reach of more people. Good billing, done right the first time as well as careful verification of benefits all contribute to a much healthier collection rate.

 

Kat Jordan is the Owner and President of Orion Billing Services, a professional external billing company specializing in Chiropractic, Physical Therapy and integrated practices. With over twelve years of experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection. Call (415) 851-1605 for more information. Subscribe to our mailing list here.

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How Much Does Your Billing Really Cost You?

I talk to a lot of healthcare professionals – here is what I’ve heard:

In-house billing can be very expensive. I have spoken to many practitioners who believe their billing takes 20-40 hours a week, because that’s what it takes their office staff. But in those hours, you are also paying for coffee breaks, sick days and illicit sleeping employeeFacebooking. Most employees are great – but having been one myself for many years, I know that the incentive to get the job done, and to get it done right the first   time, is just not as great as it is for someone who only gets paid for what they actually accomplish in a day.

If you’re already outsourcing your billing and you are reading this, chances are that you are not perfectly happy with your billing company. I’d like to know what is happening there – because frankly, I want to do a better job for you than they are doing. Are they not keeping you informed? Claims not being paid? Are you paying them too much for too little return? Is it just confusing and you’re not kept in the loop?

Doing time is moneythe billing yourself, even if your practice is small, can be the most expensive way to handle it. As the practitioner and business owner, your time is the most valuable thing you possess. The time you spend on your billing could be spent growing your business or treating patients – the things that nobody else can do for you.

You are paying for billing, no matter which route you take. You might as well have the best.  So – why are we the best?

  • We charge you only based on the claims you have been paid for. Not based on the total amount we bill out. Not based on our time. You pay only for the work we have done, evidenced by the checks in your bank account.
  • We’re good at what we do. We have many years of experience billing for Chiropractic and Phyclicking heelssical Therapy, and that is our focus, because we believe in what you do. We keep on top of changes in the industry. We keep you informed, and we are here to talk to. We don’t outsource our client’s work to other places. We know your accounts and give them, and you, the attention you need.
  • We handle the headaches so that you don’t have to. Even if most of your claims go through smoothly, those few that don’t can be very time consuming. Our only job is to make sure that you get paid.

Give us a call. I’d love to learn more about your practice, and help you collect more of what you earn.

 

Kat Jordan is the Owner and President of Orion Billing Services, a professional external billing company specializing in Chiropractic, Physical Therapy and integrated practices. With over twelve years of experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection. Call (415) 851-1605 for more information. Subscribe to our mailing list here.

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What the Heck is Going On With Your Billing?

I spoke to a chiropractor recently who suspected that there was something weird about his billing. He’d confused guyhired a large, reputable billing company and then didn’t really look at it again for about a year – understandably – he was very busy growing his practice, and thought it was all under control since the  service should be taking care of everything. Insurance checks were coming in, but as time went on he began to realize that something was off – why were there so many rejections? Why had he never received a call from his big, very expensive billing service when things were going wrong?

I emailed him at just the right time – he was ready to sort it out, and I was happy to help him with that. I got his software logins and looked into it. I even called his current billing service to ask some questions. And you know what?  That big, expensive billing company complained to me that he had never called them to have them fix his rejected claims. Of course, as gently as I could put it, my comment was, “Isn’t that what he’s paying you for? Shouldn’t you… call him?”

 

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That doctor didn’t end up becoming a client at this time, as once we sat down and took a look at what was occurring there, he realized that his front office staff could handle it until the insurance traffic was just too much for them, and doing that is going to save him a lot of money!  And that, in the end, was a success for me – though I didn’t sign a new client, it was a very good day to be able to help this doctor, and to know that his practice is going to fare better now.

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With Orion Billing you get an expert billing service, with a personal experience. If something looks off in your billing information, we call you! When we see that your office procedures need adjusting to improve your collection rate, we let you know and provide help where it is needed. I personally review all billing reports sent to our clients every week. We consider ourselves a part of your team, not just an outsourced service, and we are here to handle the headaches so that you don’t have to.

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Kat Jordan is the Owner and President of Orion Billing Services, a professional external billing company specializing in Chiropractic, Physical Therapy and integrated practices. With over twelve years of experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection. Call (415) 851-1605 for more information. Subscribe to our mailing list here.

 

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How Can a Billing Service Save You Money?

1429347647-ria6aqb6t I regularly speak to doctors who have been doing their billing in-house, but have a less than optimal collection rate. We hear the common problems over and over again.

While well-intended, the person doing the job may not have the training or experience to thoroughly handle the billing. They may not have a good system in place to keep track of their follow-up, or understand the importance of thorough follow-up. They just may not know how to deal with insurance companies to get claims corrected and get the answers you need. Often, an in-house biller has other tasks, which makes the occasional hour on the phone with an insurance company to chase up a claim almost impossible.

Outsourcing your billing is a good solution, and one that can save your practice a lot of money.

How’s that?

When you have an employee doing your billing, you pay them whether they are working productively or not.

You pay them when they are making mistakes.

When they are on vacation, or out sick, you pay them.

You pay them to be trained, and then if you have to re-hire and train someone new – you’re paying for the same thing over again.

When you expand, you may have to pay more employees to do your in-house billing – but as your professional billing service, it is our job to handle the additional workload your expansion creates.

When you hire our billing service you are paying professionals, but you pay only for the end product of the billing process – collections.  There are big companies out there that will charge you a percentage of the total amount billed, however that could be an even more expensive proposition than hiring an employee to do it. There’s little incentive to collect, and little proactive, personal attention such as we can provide to our clients.

You may have considered switching to a billing service thinking it will simplify things.  And that’s true – when you outsource your billing, there’s no employee overhead, no desk taken up in your office, no billing headaches right there in your everyday environment. It is our job to handle it for you. We keep you informed, we can be reached easily, and we ONLY get paid if we take each one of your claims seriously.

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Kat Jordan is the Owner and President of Orion Billing Services, a professional external billing company specializing in Chiropractic, Physical Therapy and integrated practices. With over twelve years of experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection. Call (415) 851-1605 for more information. Subscribe to our mailing list here.

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Why We Love Chiropractors

The day my son was blove-chiropractors-image-92kborn was the happiest and most amazing yet exhausting day of my life. Though my son’s birth was completely natural and went very smoothly, I felt like I had been hit by a Mack Truck. Having gone to chiropractors throughout my pregnancy, I knew that I needed an adjustment as soon as possible. I managed to get in to see my regular chiropractor the next day and walked out of there feeling like a new woman. Friends and family could not believe that I had just given birth. Though sore and tired, I was a long way back towards normal, and was able to cheerfully go about life as a new mom.

A few days later, I knew something was wrong. My son cried all the time. He didn’t sleep. He couldn’t eat. My impression was not just that he was a cranky newborn, but that he was in pain. Our pediatrician wanted to bring him in for potentially invasive testing, however I first wanted to see if a chiropractor could bring him some relief. I had never heard of chiropractic for infants at that point, but called my doc to ask and was told to bring him right in.

Our chiropractor worked his magic. My son fell asleep during his adjustment, and slept for four hours afterward – the longest stretch of sleep he’d ever had. He cried less and both nursing and sleep improved tremendously.img_0229edit

Before long, we found chiropractic to be life-saving again. At about 5 months old, my son began vomiting multiple times every day. Of course I was very concerned, and once again, our pediatricians wanted to conduct invasive tests. I wanted to bring him to the chiropractor first. One adjustment, and the vomiting completely stopped for three days (and his mood markedly improved!) So we began a journey of regular chiropractic visits and a search for natural and alternative methods to help my son’s body get better. The cycle would continue, with adjustments, dietary changes for both of us, supplements for both of us, and so on, with certain things working for a while and then having the trouble start again. It took a few years to fully resolve, and we met wonderful, helpful chiropractors, Kinesiologists, nutritionists, and naturopaths along the way. Though finally, with time and persistence, my son was healed, stable and happy.

I will always be grateful to the wonderful doctors of chiropractic who dedicated their lives and careers to helping people back to their natural physical stability and wellness.

Every one of us at Orion Billing has personal experience with being helped by Chiropractors. With our knowledge and experience, there are many types of medical practices we could choose to work with, though we are in a position to dedicate our work to a field we believe in, and that is why we do what we do.

 

 

Kat Jordan is the Owner and President of Orion Billing Services, a professional external billing company specializing in Chiropractic, Physical Therapy and integrated practices. With over twelve years of experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection. Call (415) 851-1605 for more information. Subscribe to our mailing list here.

 

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Follow-up!

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Follow-up is the most important aspect of medical billing. If billing were a simple A to B – submission to payment – almost anyone could do it! Thus the need for a good, professional billing company with some skill and experience. However, we are continually surprised to hear, when we talk to doctors and their staff, that their current billing services are not conducting thorough follow-up.

What goes wrong?

There are many reasons why a claim may not be paid. Submitting claims can be complex and tedious. Insurance companies can be hard to deal with. Perhaps a claim was never received, or something changed with the carrier so their computers are now automatically rejecting certain claims. In these cases, the biller wouldn’t receive a denial, and if not keeping track, they may never know there was a problem.

Sometimes claims contain simple errors that can be tracked down and corrected. Or they may be wrongly denied and will be approved if resubmitted – but to simply resubmit and then write off unpaid claims is to potentially lose a whole lot of income.

What can be done about it?

Knowing when and how to follow-up on an unpaid claim is vital to collecting the money that you have worked hard for.

We are tenacious about follow-up, and that has a lot to do with our success. If a claim did not get paid, there is a reason.  We find out what that reason is, get it corrected and addressed – and get it done before the filing deadline. We know how to talk to insurance companies to unravel the mysteries, and we do it every day.

When we take on a new client, it never fails that there is a period of cleaning up billing messes that have been left behind. There is the process of the hunt, and solving the puzzle of what went wrong with each claim. This is something that we excel in, and actually enjoy! Each claim can be traced back to the underlying reason it was denied or remained unpaid. Making the corrections, and communicating about them with the office staff results in the prevention of a great number of potential future denials. We immediately work toward getting your claims submitted correctly the first time, thus reducing the long waits between patient treatment and payment.

By reducing your denial rate, we bring more money to the bottom line of your practice. The payoff of our tenacity is the difference between a practice that’s just getting by and one that’s truly profitable.

 

Kat Jordan is the Owner and President of Orion Billing Services, a professional external billing company specializing in Chiropractic, Physical Therapy and integrated practices. With over twelve years of experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection. Call (415) 851-1605 for more information. Subscribe to our mailing list here.

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