Billing Services failure - One simple reason

Medical Practices outsource their billing to companies that specialize in providing such services. 

During my conversations with practices as well as billing service providers, I constantly hear about certain practices not happy with the services that they get. I also hear about billing companies complaining about how certain practices do not cooperate. In the end, it is the practice that has to bear the brunt because of inefficient billing and loss of revenue.

I know for a fact that each billing company has majority of happy and satisfied clients. Why is it then that certain practices end up not being happy with the services?

Irrespective of the software platform and vendor, let us look at the billing process. The practice selects the codes in most cases after the patient encounter. This may be a manual or an EHR based process. The billing company creates claims and submits them. If the submission is successful, the billing company follows up regarding payment and does what it has to do post payments, run reports, and manage the aging or outstanding balances.

Theoretically, all of this should run smoothly. There are certain points of communication between the billing services company and the practice. For example, there may be problems with

  • patient demographics,
  • insurance details,
  • errors in coding,
  • need for further clarity on claims by the insurance companies,
  • proof of documentation, etc.

This is usually a manual process that is established between the practice and the vendor. And, also the main stress point or cause of failure. The process may involve faxing, phone calls, or secure messaging. There should be a person assigned in the practice that understands some level of billing process so that they can effectively communicate with the vendor. It is this middle person that plays a very pivotal role in the success of outsourced billing process.

This person does not have to be an accomplished biller or an officemanager. He or she must have the basic understanding of billing process so that they can communicate with the vendor and act as a middle person to make sure there are no bottlenecks and nothing falls through the cracks. This is the most important element of success or failure within outsourced billing company.

EMR Demand not exciting

HHS announced an easing of the timeline for hospitals and eligible providers to meet Stage II of the government EHR incentive program. This makes State II compliance easier for those providers that qualify for State I in 2011. However, it is too late now to buy EMR software, use it for 90 days and qualify for 2011 incentives. I suspect few providers will actually qualify for incentives in 2011 (estimated at 5%).

This means that the overall impact of EHR / EMR demand is still not enough.

Free EMR Software

I have been trying for a long time to really understand the dynamics of a free EMR, both from a business perspective as well as provider point of view. I understand that almost all companies offering free EMR are web-based EMR software. Therefore the assumption is that they are in a much better position to offer cloud-based EMR where the costs and maintenance of deploying EMR is minimal.

What I don't understand is that EMR is not just a piece of technology or sofware, it is a change in how medical practices are run and managed. It is a paradigm shift. In order to provide the level of support, there must be tremendous amount of support and infrastructure investment. I don't know how the traditional business revenue model of advertising can work. Unless, of course, this advertisement model has an underlying data mining involved; of de-identified patient data.

This is the only way a company can hope to make any significant revenue.

From a Provider's perspective, I have come to the conclusion that free does not work. Where there is no commitment or skin in the game, the desired results just do not happen. Sure, there will be come trail blazing provider and younger provider that can find their own way, but not majority of providers out there.

So, I predict the free EMR model will not work.

EMR Marketing and Sales

I was just speaking to a colleague in the EMR / EHR industry about EMR sales. Are doctors buying EMR in the small ambulatory practice market? This is a small company just starting to get into the market. He said sales are 'not bad'. He claims a 'few' sales a month. In reality, this company is not doing more than 2-3 sales per month. EMR seems to be the place to be. It is incredible - have you counted the number of EMR companies (both client-server and web-based EMR) that have mushroomed in the last 18 months? Granted that the market is still young and majority of the doctors have not yet adopted EMR. But what is happening?

I'll tell you what is happening. EMR (web-based EMR or client server) is becoming a commodity. It is becoming hard to sell on features. It is becoming hard to sell value. It ultimately boils down to Price. Even before looking at a Demonstration, doctors are asking 'how much'?

How do you fight that?

One thing that has not changed over the years is how you connect with the Doctor. What I mean is, giving a demonstration that doctors can relate to. Can the Docs see themselves using your software everyday, in front of patients, when they are done with patients, when they want to access patient data any time? It does not matter how fancy your user interface, it does not matter how many features you have, it does not even matter if it is free.

What I mean is your ability to give a Demonstration that connects with the Doctor. This is a rare skill, however it is something that can be taught and nurtured. Focus on it, your sales will increase.