T-Bone Speaks: Is Medical Billing Right For Your Practice?
Do you have questions about medical billing? Are you unsure whether medical billing is right for your practice?
I get more questions about medical billing than anything else. It’s an area that is laden with much confusion and overwhelming information. My goal, in this week’s T-Bone speaks podcast, is to help dentists make a decision as to whether or not medical billing is right for their practice.
I'm really pleased to invite Hootan Shahidi (President at Cross Over Dental Enterprises) onto the podcast.
Here’s a summary of the key findings from my interview with Hootan.
WHO IS MEDICAL BILLING FOR?
Medical billing is good for offices that have cone beam and they routinely perform oral surgery. They maybe do periodontal surgery. Plus, it’s good for practices that do appliance therapy (whether it is for sleep apnoea, TMD…etc).
On the other hand, medical billing is not good for a practice that is heavily restorative, those that don’t necessarily have advanced imaging, and those who don’t perform oral surgery. In addition, medical billing is also not a good fit for offices that are demographically in an area surrounded by a lot of HMO medical clients or a Medicaid office which is state funded.
Furthermore, offices that don’t need medical billing include those that do not need the extra revenue. For example, they are fee-for-service already and have a high case acceptance rate, patients pay up front and don’t necessarily need treatment to be made more affordable for them. This represents only a very small number of practices.
When a dentist is considering if medical billing is right for them, they should ask themselves:
- Am I looking to grow my practice?
- Do I want to expand and grow my revenue?
- Am I looking to expand the number of procedures that we do?
For me personally, once we started to really understand medical billing, and we understood what procedures have good reimbursement, we started to focus on those procedures.
THE COMMON CHALLENGES FACED WITH MEDICAL BILLING
There are 3 common challenges with medical billing
1. Team Acceptance
This is usually as a result of the leader not bringing his/her team onto the same page with regards to medical billing. Some members of the team may not accept the introduction…they feel it’s yet another thing thrown at them. It’s important to involve your team in the decision to introduce medical billing, get involved in implementation, and ensure there is accountability.
2. Putting systems in place
Most offices are not willing to put in the time and effort to go through the learning curve to implement medical billing.
95% of practices do not do medical billing. Then looking at the 5% that do medical billing, half of them do not really engage in medical billing – they do it here and there, one-offs etc.
Systems need to be in place. The system in medical billing is admin – clinical – admin. Some have made the system unnecessarily complicated when it should be simple and implementable.
3. Busy schedule
Generally, complaints about busy schedules aren’t from the surgical oriented practices, or implant practices, but more so from practices where the bulk of their work is fillings and crowns (where it’s all about volume).
Implementing medical billing requires a mindset change and a practice philosophy change. People who say they are too busy are often so caught up in the day-to-day that they aren’t willing to go through the learning curve required. Implementing anything does bring about a certain amount of ‘pain’ initially!
DOES MEDICAL BILLING REALLY WORK?
Many offices that say medical billing does not work are struggling and often not giving it their best shot. It’s important that they ask themselves the following:
- How many claims have you submitted?
- Did you use the right CPT code? Are you sure you submitted your claim correctly?
- What kinds of plans are in your area?
- What kind of procedures have you submitted for?
The answers to all of these questions are very important in making a judgement on whether medical billing works.
HOW TO KNOW IF MEDICAL BILLING WOULD WORK IN YOUR PRACTICE
The first step is, over the course of 5 days, tell your team to scan the insurance cards of ALL of your patients (front and back) and into one folder on your computer.
At the end of the week, with your team, look through all of the cards and work out the percentage of the insurance cards that are PPO, POS or HMO…(it should say in the upper or lower right corner of the card).
If you see 90% PPO you should consider medical billing, and ensure you get the right knowledge on how to go about it.
If there is 90% HMO, you should have a realistic expectation that you can only bill 1 out of 10 patients at best. It may not be right for you.
If you are 50:50 then medical billing may be right for you and you should certainly consider it too.
PROCEDURES THAT CAN BE BILLED TO MEDICAL INSURANCE
Every practice has the potential to bill medical insurance. The procedures covered include:
- Surgical procedures – all oral surgery procedures can be billable to medical e.g. extractions, bone grafts, membranes, INDs
- Appliance therapy
- Trauma e.g. when patients have a broken tooth due to an accident
In the beginning focus on those things that you are giving away for free. For example, with examinations it would be that third hygiene visit that I write-off every year, or a suture removal I never get paid for. With x-rays that could include x-rays after implant extraction or after root canal…these are all areas that can be billed to medical insurance.
THE BENEFITS OF MEDICAL BILLING
- You can stop leaving money on the table. No more free consults and free examinations. Stop missing surgical steps that you don’t charge for. There are so many opportunities to recoup money that otherwise would have been left on the table
- You start doing things that you are not already doing – I have a friend who has created a whole revenue stream based on an additional procedure that is billable to medical
- Customer service – you can effectively help customers meet their deductible
HOW TO GET STARTED
The first question is, should I be entering into the medical billing game?
If you have decided it’s right for you, then decide whether to do it yourself or hire a 3rd party service.
Whether you go with a 3rd party, or do it yourself, you must learn more about medical billing. Education is really important.
It’s a good idea to work out how much revenue you want to bring in. Most medical billing companies charge 8-12% of the amount received/claim paid. If you plan to bring in $300k+ per year then you may want to consider hiring someone in-house. You need to work the numbers and find out what is right for you – assess the economics, man-power, feasibility…etc.
For 80-90% offices it’s not realistic to start in-house, the majority will start with a 3rd party. They may get to the point of hiring in-house but it’s not the best option when starting out.
Thanks for reading, I hope you feel a lot more informed about whether medical billing is right for you and your practice.
This article originally appeared on tbonespeaks.com.