If you use a small billing service, do you know what they are doing with your smaller claims? I was looking over a client’s collections and as I dug into the numbers, I was able to see how many claims were getting changed to patient responsibility after a denial from the insurance company and it is costing that practice a lot of money.
My experience has taught me that calling the insurance company can resolve an overwhelming majority of denied claims and, once fixed, they get paid in record time.
The issue is, though, that it takes time. A call to the insurance company generally starts with 30 minutes on hold just to get someone on the phone who can help, so it can take a long time when you have even just a handful of denied claims.
Let’s say you charge $130 for a 99213 and your average payment is $78.00. The insurance denies the claim saying coverage was terminated, but a phone call or two could probably fix the concern and lead to payment*.
Your billing company has a decision to make.
Option 1: Pick up the phone and make the calls.
Option 2: Change it all to patient obligation, send a statement and passively follow up with subsequent statements.
It seems that all of the small billing companies I have seen lately are choosing option 2. They do the math and, at 6% of that average payment, they will get less than $5.00 for the phone calls. It’s far more profitable for them to spend their time trying to get new clients than it is to spend the money on collecting smaller balances for the clients they have.
When your company chooses option 2, they are providing a lot of insight into how they do your billing and how valuable you are to them as a client.
First, this shows that they are lazy when it comes to your billing. Most claims are paid without incident so they count on that and send almost everything else to the patient.
This also shows they don’t really value you as a client. They need to look at your total practice in terms of the collections they are able to achieve and not ignore the smaller ones. They should see that those charges add up quickly and that they are servicing a $2.5 million dollar practice, not making a series of decisions about $130 claims.
The fact is, so many practices are not collecting everything they should. Ask questions about your smaller claims. When you see a lot of things going to patient balance, don’t just focus on the bigger ones. It is more likely that they can tell you exactly what is going on with the bigger ones and they have a legitimate reason for going to the patient. After all, the biller will spend the time on the big ones. Instead, ask questions about the smaller ones. If your biller can’t speak to what they have done to collect the smaller ones, it may be time to find a new biller.
*This is assuming your office verifies insurance prior to appointments.