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Startup Spotlight | Sept '13

I Don’t Have a Biller

The headline is not a typo. I really don’t have a billing person. Not one in house and no outsourced company. Nothing. >BOOM< How crazy is that?

Against all odds, and against all advice, I made the decision not to hire a billing person(s). How did I come to this decision? Simple math. In my practice, I use Modernizing Medicine’s EMA Ophthalmology for electronic medical records. This program analyzes my notes and puts together all the billing (ICD-9s, CPTs, modifiers) and sends it to my practice management software. My software, Care Cloud (Care Cloud Corporation), scrubs the data to make sure it all makes sense and then electronically submits the bills to the different insurance providers. Electronic fund transfers are tracked and applied to the patients’ accounts automatically. Any denials, rejections, or unpaid accounts are highlighted for my front desk staff to see. If they click on a denial, they can see the reason for denial, as well as a link to assist them with refilling the claim. My staff, none of whom had ever done anything with billing, find the system easy and intuitive to learn. In fact, at one point I did have a billing expert come to my practice for possible consultation. Her opinion after seeing the system: I’d help you so few times, it wouldn’t be worth the cost.

Out-of-office billing sources, while effective, will keep about 6% of whatever is collected, and they do not have 100% success with collections. An in-house billing person will cost more than $50,000/year, and he or she still may not have 100% success with collections. Our first pass-through rate (relying purely on what our electronic medical records/practice management systems tell us to do) is well over 95%.

So, even if I’m not billing “perfectly,” I’m still coming out ahead financially. Though it’s a complete change in the way most practitioners think about setting up an office, for me, the decision to not have a billing person has overall lowered my practice’s overhead and increased its profitability.

David A. Goldman, MD

David A. Goldman, MD, is the founder of Goldman Eye in Palm Beach Gardens, Florida. Dr.Goldman may be reached at (561)630-7120;david@goldmaneye.com.