The Challenges of Radiology Billing for Small Groups

What is a unicorn? The mythical creature is sometimes represented as the unattainable. In this case, the “unicorn” is small radiology groups trying to successfully self-bill.

In times past, it was possible for small groups to self-bill. Billing (and life!) was simpler back in the day. Today, billing is complicated and expensive. A good billing platform may run a quarter of a million dollars and take considerable time and effort to learn and implement. Small groups do not have the money or the resources to bill for themselves any longer.

Challenges Facing Small Radiology Groups

With most small radiology groups being run by an office billing manager, it is nearly an impossible task for them to keep up with the changing landscape of medical billing, not to mention the rising costs of a do-it-yourself approach. Obstacles in this feat include, but are certainly not limited to…

    • Regulations (compliance, MIPS, etc.)
    • Code changes
    • Time to manage staff
    • Auditing
    • Ensure accurate charge capture
  • Denial management

Now, this is not in any way a criticism of these small office billing managers or the people they manage. Some of them are, quite frankly, close to superhuman. We are simply asking too much of them in this day and time.

Definitions vary as to what a small radiology group is, but for this post, we’ll consider a small group anything less than 20 FTE radiologists.

In billing terms for small groups, let’s define the unicorn by three measures:

  1.       High net collections for a given patient mix
  2.       Good AR management (low Days in AR)
  3.       Low billing costs

Of these, a small group may attain two of the three, but not all three. Attaining all three is the unicorn. You can hire lots of experienced billers and coders and implement an expensive system, but your costs will spiral upward. Frankly, of the three, having higher billing costs would be the better path versus the other two options. As you have heard me preach, billing costs is not where most groups are losing the most money. They are losing more money on poor collections and AR management than in billing costs. You may get tired of my repetition, but it is always worth repeating, it is silly to save ½ point in billing costs only to lose 5 points on collections. It happens all the time.

You can have a normal ratio of billers/coders to radiologists keeping your costs in check or even outsource some of the processes overseas, but you will inevitably sacrifice either high net collections or good AR management—probably both.

Does this mean larger groups are doing it right? Hardly. Just the virtue of being big is no guarantee of billing success, but it does make it reasonably possible to attain. The reason is straightforward; larger groups have the ability to reach reasonable economies of scale and efficiencies that smaller groups cannot.  They also may have more opportunity to leverage improved technology, support resources and expertise to support them along the way. This is exactly what Dexios provides clients.

Inevitably some small group is going to say, “we’re a unicorn.” They may be out there, I just haven’t seen it in recent years. What happens is people claim unicorn status but it doesn’t stand up to scrutiny. All too often small groups look on paper like unicorns but it is because they are not using RBMA standard definitions for write-offs and adjustments, have poor reporting masking what is really happening, not accounting for all billing costs, etc.

What do you do if you are a small group that is self-billing?

  1. Continue to pursue the unicorn (or believe that you are the unicorn). If you think that you are the exception and can keep up with always changing billing landscape, I’d love to have a conversation with you.
  2. Merge with a larger group or sell. Lots of people are choosing this path. Obviously, this has a lot of implications beyond billing.
  3. In-source your billing. This is when a billing company like Dexios takes over your billing employees and gives them the resources and management they need to be successful – often for the same or less than you are paying today. You get the benefit of the same people doing your billing perhaps even in your office, but with better tools and economies of scale. This is the least disruptive path with the least risk.
  4. Outsource your billing. This is a reasonable option, but one that many small groups misunderstand, so they continue self-billing and pursuing the unicorn. What they may not know is that with outsourced billing you are in control over which functions you want to do and which you want to give to someone else. Continue to do what you’re good at, leaving other tasks to someone better equipped to perform.

Dexios provides a free, no-obligation analysis of your billing. It is fairly quick and painless. All we need is some basic billing reporting. Contact us today to get started!

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