April 2, 2019
Plastic surgeons with a blended reconstructive and aesthetic practice commonly outsource insurance billing to a third party billing service. And too often the billing company is selected solely for having the lowest service fee with little consideration given to its business acumen, coding and reimbursement knowledge, and use of technology.
Consider the plastic surgery group in Arizona who said their insurance accounts seem to go into a black hole. Sure, the surgeons receive a monthly packet of reports, but they admittedly do not understand them and so they rarely review them. The account manager is always too busy to meet and explain the reports, so the surgeons just hope they are getting reimbursed for their work.
Or there is the plastic surgeon in Tennessee who engaged a local third party billing service that uses their own proprietary software system to manage insurance claims. The practice staff don’t have electronic access to patients’ accounts balances, so they miss the opportunity to collect when a patient is in the office. Moreover, when the practice staff do collect a copay or a surgery deposit, they cannot post the payment and instead log it on a spreadsheet for the billing service to post it in their separate system. The disjointed process means they do not perform a proper daily close, leaving the practice at risk of embezzlement.
When selecting a billing service, evaluate more than just the service fee. A good billing service will:
1. Allow easy access to your data.
Best case, the billing service bills directly from your practice management system (PMS) and you retain full visibility and control at all times. When the billing information lives in your PMS, you can view patient accounts, post payments collected in the office directly to the account, and run reports in real time. If at some point you decide to switch billing services or bring billing in-house, it is a simple matter of turning off login access to the billing company.
If your practice has an aesthetic practice management system that does not support insurance billing, it may be necessary for the billing service to use another software, but you still can maintain control. John Gwin, CEO and founding partner of The Auctus Group, says he helps the practice get a license to his preferred billing software. “We have it set up under the practice or doctor’s name and then we login and bill from it. They are the primary controller, we just operate it. They have full visibility of the work we’re doing and can lock us out at any time.”
2. Keep your data safe.
Don’t assume a signed Business Associate Agreement (BAA) automatically means the billing company’s employees are fully trained on privacy and security of protected health information (PHI). A good billing company can provide proof of annual HIPAA training and has policies and procedures in place to protect patient data.
Plastic surgeons should be particularly concerned about electronic communications. PHI should never be sent by email to or from the billing service unless within a secure, encrypted message that requires a password to open.
3. Provide monthly reports and metrics.
A good billing service provides a standard monthly reporting package that includes more than a summary of charges, payments, and adjustments. Insist on reports detailing aged accounts receivables by payor, with insurance and patient balances shown separately. Ask for the details of write offs and adjustments, credit balances, and large unpaid accounts.
With the reports, have the billing service create a dashboard that compares metrics to industry benchmarks. Metrics indicate how well the billing service is doing its job and should include Days in A/R, Percent A/R > 90 Days, and Net Collection Ratio.
4. Have deep experience and credentials in plastic surgery coding.
Our strong recommendation is that the surgeon be the one to select the codes, but billing service staff must be capable of applying modifiers, providing feedback about the codes submitted, and effectively appealing denials.
KZA consultant and speaker Kim Pollock, RN, MBA, CPC, CMDP explains, “Procedure and diagnosis codes are updated annually, and payor reimbursement issues constantly occur. The billing service, just like surgeons, must stay current on plastic surgery specific codes to ensure coding accuracy and to prevent or appeal denials.”
As a customer, you should expect that the company you’ve entrusted your accounts with invests in employee education. KZA offers customized plastic surgery coding and reimbursement training.
5. Implement modern technologies and time saving tools.
Modern technologies in the revenue cycle have made phone calls, faxes, and paper-based systems a thing of the past. Sophisticated billing services optimize tools such as front end code edits, electronic work queues, online channels for claim status, electronic funds transfer (EFT), electronic remittance advice (ERA), and denial management technology for rapid resolution of denials and under payments. Also, ask about options for sending electronic patient statements and accepting online payments.
6. Recommend improvements.
The billing service should not only produce monthly reports but also give feedback on performance and identify issues. “A strong billing service will come to you with ideas before you think of them,” says Gwin. “Just like a good employee, you want someone who takes initiative.”
The billing service is an extension of your practice staff, and therefore must be managed. Commit to regular meetings to review the company’s performance and expect feedback about your documentation and coding, authorization issues, and denial patterns.