When Dr. Marylyn Chambreau of Los Altos, California, became a chiropractor 10 years ago, it was with the object of practicing good chiropractic, not in being a billing administrator.
"There's a joke that the best day in a chiropractor's life is the day she gets a computer, and the next best day is when she gets rid of it."
Dr. Chambreau's lament is legion in the health professions. "Insurance has gotten so complicated," she said, "and I have no desire to develop the necessary expertise to keep up with it."
Indeed, "keeping up" is more difficult than ever before, with the array of payment plans -- and the seemingly arcane rules governing the ever-increasing complexity of the forms to be filled out.
So, Dr. Chambreau did what thousands of her fellow practitioners are doing, she selected an outside firm to handle her billing.
In fact, so many doctors in all fields are choosing outside firms to hand their billing that, according to home business guru Paul Edwards, health billing services rank as one of the 10 "Best-Bet Businesses" for the '90s.
Whether a chiropractor should turn over billing services to an outside firm depends on a number of factors including practice size and profitability.
"Those businesses that are marginal see an outside billing service as an additional expense. While those that are more successful can buy their own computer and do the billing themselves," Mr. Edwards said.
The Numbers Game
Growth in the health end of the "billing industry" is supported by a number of sources.
Joseph McLarney, president of a software company and developer of patient accounting software, says it's one of the fastest growing segments of his business. "About 10 percent of our sales are to individuals either opening or operating a small billing service for health care practitioners," he said.
Because of the growing complexity of the medical reimbursements, many chiropractors are washing their hands of the process and turning to billing services. One recent example of this complexity was when Medicare's Health Care Financing Administration (HCFA) changed the venerable HCFA 1500 insurance claim form. HCFA also changed all the evaluation and management codes making them incompatible with the old codes. As a result, physicians are having problems adapting their software to the new codes to document their services for Medicare reimbursement.
"For better or worse," said Mr. McLarney, "the future of health care clearly points to a complex scenario of physicians having to understand and be fluent in filing documentation for reimbursement. For this reason alone, they are starting to seek outside billing help ... because they don't have time to keep up with it."
Processing the claims "in-house" often leads to medical office personnel frustration, billing backlog, claim denials, and unhappy patients. The result can be a financial nightmare. Worse, insurance companies, Medicare, and patients don't care about the physician's billing potpourri.
"I went into one doctor's office where patient files were just stacked up on the floor," said Frazier Thompson, owner of a billing service in Memphis. "In another, there were five people in the office trying to keep track of things manually. It was a bottleneck nightmare.
"That's the advantage of a company like ours. We keep track of all the regulatory changes and take the drudge work out of the doctor's life. The doctor is divorced from the business side and can concentrate on being a good health provider."
Confidentiality is a genuine concern of any physician who relies on outside billing services. Records are confidential and, as such, doctors are extremely sensitive to information leaving their possession.
Debra Wilson owns a computer data service in Fremont, California, a company that serves primarily chiropractors. She solved that problem by physically picking up the work files from the doctor's office and then returning them immediately after completing the billing.
Paying for Billing Services
Chiropractors have numerous payment methods from which to choose when considering a billing service. Wilson charges a standard fee on a per active account basis, rather than by the piece or the bill.
"It's easier to keep track of and the less active accounts make up for the more active ones. We'll negotiate a standard monthly fee, regardless of the number of accounts, when a practice is fairly stable."
Some billing services charge $25 per hour while others may charge from a set dollar figure -- about $3.00 a claim -- or a percentage, say three percent. If physicians key in the work, they can save some money. On the other hand, if the billing service keys in the information, they may pay additional charges.
Some physicians are finding services with a "You don't get paid, we don't get paid" philosophy. These services get paid only for bills on which doctors actually collect.
Payment methods depend largely on the level of service provided, which can range from straight, tradition billing to electronic filing.
Mr. Larney's cautions about the expertise of these services. "You can't just plug in medical billing software today and expect to be in business tomorrow. This field takes specialized knowledge about diagnostic coding and claims filing procedures." For that reason his company has prepared a software program that performs comprehensive accounts receivable functions and integrated insurance billing along with special chiropractic features.
He offers one further word of advice -- when dealing with a billing services company, first consider one with a software package that will allow you to file electronically (rather than physically mail) a claim; and make sure the software can be inexpensively updated to keep pace with changing HCFA claim requirements. Medicare is all but mandating electronic claim filing and, besides, there's the advantage of getting paid in about 10 days as opposed to as long as six weeks.
Next to treating a patient's ailment, processing claims for payment is the most important function in chiropractic practice. And choosing the right billing service can make life easier and business more profitable.
Dr. Chambreau gave up doing her own billing after three years. "Because I'm ultimately responsible, I attend seminars to see what's going on in this area. But it's a relief to have a professional handle that end of my practice."
Additional information is available from the American Association of Billing Professionals, (813) 365-3357; and from the National Association of Claims Assistance Professionals, (708) 963-3500.