Should you outsource therapy billing or use clinic billing software to do it in-house?
There are pros and cons either way. This article aims to highlight the advantages and disadvantages of each so that you can make an informed decision.
In-House Billing for Therapists
Lauren Lobert, DPT, OMPT, CSCS and owner of APEX Physical Therapy said, “I can’t imagine giving up 5-10% of my profits for the amount of time and energy it takes to do the billing ourselves.” Her clinic has two therapists and a front office staffer.
Lobert opened her practice about a year ago, and she decided to do her own billing so that she would understand everything going on in her practice. When she started out she was only billing for 20-30 visits a week, so it was manageable while she learned the process.
The Learning Curve
She used to do all her own billing, but now she’s trained her front office employee to handle it in less than 10 minutes a day. However, there is a learning curve. According to Lobert, “At the beginning things take longer as you troubleshoot.”
Things get tricky when you receive claim denials. “You might get an ERA back without being paid, and you might not understand the codes explaining why.” Lobert said that after contacting the insurance company to get clarification, you’ll know what to do the next time it happens. “It’s usually a simple fix,” she said.
Another thing to think about before you bring billing in-house is the importance of keeping up with the changes in billing and coding each year. Chrissy Dickson, Fusion Web Clinic’s Medical Billing Specialist, said “There are typically several changes made by the CMS each year that can have major effects on your clinic.”
Lobert made some mistakes along the way, but fortunately none of them were irreparable. It took longer to get paid when she made a mistake, but she was able to get everything worked out eventually.
Lobert’s front office person currently handles billing for 80 to 90 claims a week in 10-15 minutes. The difficult part is keeping track of who to submit the claims to and handling denials, but Lobert estimates that in-house billing is saving her about $3,500 to $4,000 a month, so she feels it’s worth the expense.
Beth Morgan, president of Medical Bill Consultants, runs a consulting company that advises therapists and other medical providers on billing matters. She says billing in-house is much easier. “If patients call up with questions, you have someone right their who can easily access their account and answer questions for them.”
If you do hire a billing company, make sure they’re reputable. Morgan has seen providers get in trouble for mistakes made by billing companies. “People forget that when you hire a billing company, it’s still your name that goes out on the bills.”
In-House Billing Tips
We asked Chrissy, Morgan, and Lobert for some tips for clinics that are planning to bring billing in-house. Here’s what they said:
1. Hire Someone Certified
Morgan recommends that, if you do decide to bring billing in-house, you hire someone who is AAPC, AHIMA, or AIHC certified to make sure they know the ropes. They should also be familiar with the rules and regulations for your discipline.
Submitting incorrect codes or modifiers can delay getting paid. Having a certified biller/coder helps to ensure that you are up to date with the latest changes made by the CMS each year.
2. Watch Video Courses
If you plan on bringing billing in-house, Lobert recommends watching video tutorials to begin learning about the process. (Fusion offers a video course here.)
3. Find the Right Software
You’ll also need therapy billing software of course. Fusion Web Clinic offers automatic claim generation, electronic remittance automation, and more. You can centralize and manage all payers from one place, and submit thousands of claims with one click of a button.
If you have the time or are able to hire someone, billing in-house can save you money. An outside billing company might not work as hard to get denials processed, and they don’t know the full scope of your practice and your patients.
On the other hand, if you’re not careful to get your claims right (or you hire someone who doesn’t know what they’re doing), denials could interrupt your cash flow. Additionally, if you hire someone specifically for billing and you don’t see enough patients to pay their salary, your clinic will struggle.
Only you know what’s best for your clinic. Take a look at how many patients you see, how much revenue you bring in, and decide which option makes the most dollars and sense.
In-House Billing Kit
We’ve put together some resources to help you bring billing in-house. This In-House Billing Kit includes:
- A Verification Questionnaire to use when calling payers to verify coverage
- A 50% off coupon for our billing course, The Essentials of Insurance Billing for Therapy
- A Billing & Collections Checklist to guide you as you interact with caregivers
- A Payment Policy Generator to help you set expectations for caregivers
- 7 Tips to Help with Billing & Collections handout