Two Sides to Every Story: A Lesson in Radiology Billing

I’m active in a radiologist forum where the topic of radiology billing comes up frequently. Not too long ago, several posts were made about the poor quality of billing companies. Here are some excerpts of the comments:

“Our billing office also does not give us guidance (on dictation, denials, etc.). I get a lot of good pointers here, but none from our billing people.”

“Excruciatingly painful to get billing company to provide clear data and help. Ongoing project for 2 years with poor responsiveness, roadblocks, delays. Highly frustrating.”

“Here's the problem with billing. They get a percentage. So, the best way for them to get the most money for least effort is to keep minimal staff and do the easiest collections.”

“I would add that once you get the detailed reports from your billing company you have to be certain that what is being reported is accurate. My experience in that regard dates back approximately 15 years ago. We discovered through an outside accountant audit that the reports were so inaccurate as to be considered fraudulent.”

“I told our boss we should, incrementally, take over our own billing; we then had a nice laugh together.  We did switch billing companies, and the new company was worse than the old one. As stated above, they get a percentage of revenue. It's better for them to recruit new business rather than fight denials.”

Only One Side of the Story

Sadly, these observations mimic what I see in the market as well on occasion. However, this is only one side of the story. What follows is my response to which one radiologist responded “Get It? Got it? Good! —If you’re in charge of your group's billing and collection, copy the above and frame it.”

Disclosure: I own a billing company, and I’ve seen it all.

Here’s the inside scoop from someone who’s been around…

Improving dictations

First, a good radiology billing company (and there are a lot out there) will tell you how to improve your dictation and do so before the case is billed giving you an opportunity to addend the study. They will give you verbiage for your templates in cases where they see improvement or ambiguity. Most billing companies (good and bad) will not upcode. It's illegal and bad business. And, by the way, I have radiologists and administrators that ask us to upcode all the time. We don't do it, and tell them why we won't so it is not a one-sided affair. If your coders won't help you with dictation and addendums, you need new coders unless you are just working them so hard they do not have the time (which is possible).

Paying a percentage

Second, on paying a percentage of collections, it is true that there is a declining incentive to go after hard dollars. If you are paying 7% of collections for example, this means that the billing gets $7 for every $100 they get for you. Once their collection costs go above $7 for that next incremental $100, they are no longer incentivized to collect it. You are losing $93 per $100 at this point. See the problem?

I would argue that most radiologist groups focus way too much on billing fee rather than optimizing the True Cost of Collections (total billing costs vs. what is collected). Far too many of you guys save 1 point on fee only to lose 5 points on collections. You shop price and then wonder why you get crappy service (low collections, high Days in AR, patient complaints, missing PQRS, bad reporting, etc.). The maxim "you get what you pay for" applies. Guys like me who do it right get frustrated when we lose out to one of these churn and burn billing companies over 1/2 point in fee. It is the rule versus the exception. You do this and then you complain about it and think all billing companies are bad. As they say, the definition of insanity is doing the same thing over and over and expecting a different result.

Audit for qualitative issues

Finally, all these qualitative issues are easy to spot in a billing analysis and audit It's simple for someone like me who has been doing this for a long time, I'll do a cursory audit for free. If I dive deeper to fix issues, we’ll charge a consulting fee, but the basic end of month reporting will tell the story quickly. If you’re not sure your billing is good or bad, you have no one to blame but yourself.

Even in this forum you hear guys bragging about their mediocre Days in AR like they hit the lottery. The data is out there. Join the RBMA and buy their AR Survey. It's cheap, maybe only $200. If you don't want to do it yourself, hire a consultant or get someone like me to do it for free.

Are you losing millions?

Let me tell you, depending on the size of your practice, some of you are losing millions. I just reached a year anniversary with a new client (12-man hospital-based group) whose net collection percentage was well above national averages when we took them over. Dexios is putting $500K more in the bank for them than the previous company. They were above average so think about what is happening to the 50% of you below average...  

Learn how to regain the money you’re losing, contact Dexios today.

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