Billing and Revenue Tips for a Financially Optimized Practice

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Billing and Revenue Tips for a Financially Optimized Practice

When starting a new practice there are several decisions to be made in a relatively short period of time. In order to successfully launch a business and start a revenue string, one of the first, most common decisions is to hire a billing company to run the collection end of the business. Partnering with an experienced billing entity and utilizing integrated in-house practice management software are key steps to keep your practice secure and organized. Here are some tips on what you can do to keep your practice successful from the start.

Keep Billing Information Internal

When external billing companies are engaged, it is not uncommon for these entities to request claims to be forwarded via a HL7 interface or in a Superbill format. This is done so the billing information can be loaded into the billing company’s software. The problem with this approach is the clinic is transferring 100% of its billing information (revenue) to a secondary party. Should the relationship between the clinic and the billing entity need to end, the clinic is left at the mercy of the billing company who now possesses all of their billing information. At this point, things become a little complicated for the clinic. Having to change billing companies and obtain the data from the previous billing company can be quite a hassle. It could be considered comparable to having someone else manage one’s personal checking account, which is never a good scenario. Thankfully, there is a more effective approach to managing the business’s revenue while still using external billers.

In-House Practice Management (PM) Software

The clinic needs to be able to own and control the billing/practice management software. This way, the billing entity must log in to the clinic’s software in order to gain access to work on the claims. This method keeps the collection information contained within the clinic’s control. If sometime in the future, the billing relationship must be terminated for any reason, the clinic has the capacity to bring in a new biller or billing company with minimal difficulty. They can easily transition a new entity to continue working the billing side as all the information is in-house and controlled by the clinic. Billing companies may be resistant to using the clinic’s billing software, but this should be a non-negotiable issue as the downside loss to the clinic can be huge.

Having the Practice Management software remain in-house is critical. The scenario can further be optimized for productivity by utilizing an integrated EMR/PM system. There are many benefits to implementing such a system:

  • Claims are automatically generated in a PM system when the provider closes an encounter
  • Progress notes and assessment info can easily be checked by the biller
  • Demographics and scheduling is done in one system
  • There is no interface issue to fail between the EMR and PM systems as they are one

It even goes further than that. With an integrated system, such as PrognoCIS EHR, front desk staff can quickly check eligibility for patients via the clearinghouse before services are rendered. Integrated systems also generally allow a high percentage of transactions to flow digitally through the system for processing. Likewise, EOB and Rejections also come in and out of the PM system for easy access. An office manager using PrognoCIS can quickly look at the receivables coming in on a daily basis and obtain any number of financial reports to determine the health of the business.

While purchasing Practice Management software may be a bit of an investment for a new practice, it is a wise decision in the long run. Having stronger control over the practice’s revenue is beneficial for the clinic as it enables them to optimize their collections and secure their billing information. With the capabilities of an integrated system, the clinic is better equipped to manage their billing and maintain the practice.

Authors: Charlie Cumalat

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