Steady cash flow is a critical component to the overall success of a private practice. For many practices, insurance claim payments make up a significant percentage of incoming cash flow. However, insurance claim submission can be overwhelming and burdensome on practitioners who do not have the capacity to devote time to completing the insurance billing process.
To avoid cash flow delays, some private practitioners look to a billing service option to make sure that claims are submitted with accuracy and remitted efficiently. Practitioners have three main billing service options: hiring an in-house biller, working with a third-party billing service, or working with a billing service integrated with their EHR.
Some practices hire a part-time or full-time biller to handle the insurance claim submission and remittance process. Often times this in-house biller will also be the practice’s office manager. With this option, the claim submission process will likely happen quickly because the in-house biller is on staff to complete insurance billing on a cadence dictated by the practice. If the practice prioritizes hiring a biller with in-depth insurance billing experience who will be capable of submitting claims and posting remittances with accuracy, the in-house biller’s work will likely be high quality.
However, hiring an in-house biller can be very expensive and cumbersome. Employee benefits, taxes, and wage expenses of hiring a high quality biller will add up quickly, especially for smaller practices. Having an in-house billing staff member also puts the burden on the practice to manage the biller, which can be particularly challenging for solo provider practices. If a biller is to terminate their employment unexpectedly, this can be disastrous for the income of the practice. Vacation, sick days, and family emergencies can also lead to delays in the practice’s insurance billing cycle. Employee training can be very costly as well.
A third-party billing service is either a billing company or an independent biller that will submit insurance billing claims and facilitate the recouping of payment. Medical billing services will usually charge fees by a percentage of the claims collected. Generally, the billing completed by these third-party services will be high quality because the service is incentivized to collect on claims. If the service does not collect on the claims they submit, then they will not receive their percentage fee. The third-party biller option tends to be more affordable than hiring an in-house biller, but this can also be dependent on the number of claims the practice is submitting per month.
Third-party billing services often submit claims on a once per week or even once per month cadence, which can cause cash flow delays for the practice. Depending on how the billing service operates, the practice may also need to send information for claim submission separately from where the information is recorded in an EHR or practice management system. Having to replicate and send claim information to the third-party billing service can add further delays while also leading to decreased visibility for the practice in their claim submission process.
A billing service integrated with an EHR platform means that the practice pays an extra fee to their EHR platform so that the EHR billing team can handle the insurance billing process. Integrated billing services work with the information the practice inputs into their EHR system, like session notes, diagnostic and CPT codes, and patient demographic information, to submit claims and post payment.
Much like the third-party biller option, most EHR billing solutions charge their fees based on a percentage of the claim collections. This means that they are also incentivized to collect on the claims, because that is how they get paid as well. The costs associated with using an EHR integrated billing service can potentially be offset by the increased level of remittance incoming to the practice as result of the high quality billing. Working with an EHR billing service also gives the added benefit of access to a dedicated billing specialist team working consistently to ensure that claims are paid in a timely manner and with reduced errors. All of the information needed to submit the claims is already available in the EHR system, so practices do not need to duplicate and forward any information on to the billers. This means the integrated billing service can perform insurance billing for a practice with efficiency and accuracy.