Billing Methodology that Gets You Paid in Full and On Time        Most Watched Videos>>

"Increasing complexity of billing creates opportunities for the payers to benefit at the expense of the providers. Endless claim denials, payment delays, and post-payment audits are all too familiar symptoms of dilettante medical billing. Doctors require professional solutions."
-Sigmund Miller, DC
Executive Director
Association of New Jersey Chiropractors

According to the Office of Inspector General (OIG), an overall claims submission error rate in 2005 reached 67 percent, resulting in $285 million in improper payments. Naturally, a similarly huge amount was also underpaid.

Ideally, the billing encounter should be viewed as a win-win situation. But if you are a practice owner or billing manager who has spent time "in the trenches," you must know that this is simply not the case. Insurance companies adopt an adversarial approach to providers. Under the payer's "system," the goal is to keep as much as possible of the provider's money without violating the timely payment laws. Payers delay claims processing, underpay, return for payment refunds, and impose penalties.

If you're like most practice owners and managers who hit "low collections," you might blame your setbacks on insurance companies or billing personnel. Don't. By placing the blame elsewhere, you'll cheat yourself of a valuable opportunity to improve your profitability. Instead, take a good, hard, dispassionate look at what you're doing. Chances are you'll find the fault lies somewhere within your office: your attitude, your processes, or your technology. Our research has shown this to be particularly true for practice owners or managers experiencing any of the following common billing problems:

Insurance companies . . .

  • increase your denial rates
  • ignore your appeals
  • audit your medical notes and impose refunds and fines
  • You . . .

  • lack consistent and integrated billing methodology
  • employ incompetent and/or lazy billing service that collects fees on easily paid claims and forfeits difficult claims without follow-up
  • are unable to identify and discover specific reasons for specific underpayments
  • While the telltale signs of billing underachievement may appear countless, the true causes are generally quite specific and their roots can be found in the overall approach you take to the billing process.

    Payer's Strategies to Derail Billing Efforts

    In the "provider-payer dance"-Billing Precision's metaphor for a claim payment interaction-there are always two systems at work: the provider's system and the payer's system. To lead in this process, you must know and apply a billing system that works. Merely submitting claims and placing yourself in the arms of the payer, and waiting to get paid, is not enough.

    Whether you lead or follow in the provider-payer dance depends on how effective your system is. To take control, you must be fully aware of what's happening at each step along the way. You also must be comfortable in a leadership role. Billing Precision's experience shows that most practice owners and managers struggle and often fail because they do not know how to be in control of the payment process.

    Payers have developed a simple but effective bag of tricks to seize control of and rapidly derail a significant portion of billing efforts. They typically employ five strategies:

    1. Increase billing service costs with added complexity and new denial reasons.

    2. Reduce allowed fees.

    3. Increase leverage over providers through consolidation.

    4. Underpay claims.

    5. Return for post-payment audits, demand refunds, and impose penalties.

    Chiropractic has especially demanding conditions in terms of office automation because of high processing volumes, low average claim payment value, and a uniquely high likelihood for audit. First, chiropractors see many more patients than any other specialists, often exceeding the average family practice visit frequency by an order of magnitude. Chiropractic is also the fastest growing specialty in terms of Medicare reimbursements that grew from 11.2 million services and $255 allowed in 1994 to 21 million services and $683 million allowed in 2004. Hence, simplistic SOAP note management and traditional electronic patient scheduling alone are not powerful enough for meaningful productivity improvements.

    Next, at an average reimbursement is $28, 82% of chiropractors supplement their revenue with retail product sales at the point of service. So, chiropractic billing software must be able to handle the widest range of financial arrangements, including insurance and cash payments, retails sales, and care plans. Third, chiropractors face the highest rate of post-payment audits. Hence the special importance of audit risk and pristine SOAP note management techniques. Chiropractors need the most sophisticated office management infrastructure, yet they have the least extra cash to afford it.

    Billing Methodology for Improved Performance

    Billing Precision shows a better way.You may not get every claim paid - but, by using our service, you'll get more claims paid and you'll certainly know what's happening on each step. And, more importantly, you'll know what to do about it!

    Contact us for an interview with a Billing Precision representative and see a comprehensive online demo of our Practice Management System today.