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Transforming Medical Billing Into a Competitive Advantage
By Rich Papperman, MBA, CHBME

Health care professionals typically view medical billing as a mundane clerical function. Software applications automate the billing process, generate bills, and drive collections. What could be more basic? The process is not worth a second thought as long as it functions smoothly, which is why providers and physician practices are often happy to relegate billing to third parties.

Meanwhile, changing payment models, relentless downward pressure on reimbursements, and more complexity from payers are pushing providers to seek low-cost alternatives to in-house billing for the collection of rightfully owed money. Cost-effectiveness, convenience, and confidence have become key drivers, especially for smaller care providers and physician practices.

Precisely because of these changing dynamics, billing can no longer be viewed as a simple clerical function. It has become much more strategic to the health care enterprise. Billing data is a rich source of vital information that impacts the entire care practice.

The Transformation of Billing
Why should the health care industry buy into billing as a strategic function? A one-word answer: measurement. Mining the voluminous insights in billing data can yield valuable information to better optimize a provider's practice. For example, data reporting associated with the billing function can point out how time can be allocated more efficiently from an operational and clinical standpoint.

The challenge for those providers who have opted for third-party billing is choosing the right partner. One option is national billing companies. National billers tout the sophistication of their billing technologies and claim to offer powerful algorithms that continually improve business performance by identifying and correcting problems that might otherwise result in claims denial. Other providers and practices choose to leverage the billing services of a large health system or integrated delivery network (IDN). The IDNs tend to invest heavily in centralized enterprise IT systems, including integrated clinical and revenue cycle management systems. They have been aggressive in their efforts to take over billing for member organizations, effectively locking them into their systems.

The third option is one that is growing in use and acceptance: local third-party billers. They are no longer excluded from the technological advantages of their national rivals. They, too, have access to sophisticated analytical capabilities and powerful, algorithmic-based billing software often built on the same technology platforms used by large IDNs. Because they are local, these billing companies are able to provide one-to-one service and serve as strategic partners to the practices they serve, yielding improved results and lower costs.

Local billers are in a unique position to offer personalized, "high-touch" service that IDNs and the national billers, due to their size, are not likely to match. As a result, a local biller can become a trusted business advisor in the same way a good certified public accountant goes beyond filling out tax forms to provide strategic advice on the business and its operations. By using analytics to leverage the wealth of data in medical billing, a local biller can help clients optimize their all-important topline revenue.

When choosing a medical billing partner, it's important to look for the following key deliverables:

• Great service: The future belongs to those who can elevate customer service from good to great. Exceptional service means continually exceeding expectations. Great service is proactive, enabling the health care practice to be equally proactive through continuously updated insight at the point of action. Great service means being valued as a trusted business partner, not merely as a vendor. The right partner will have glowing references to confirm these traits.

• Great technology: Advanced technology is essential to provide strategic value. Great technology improves both operational efficiency and effectiveness, keeps costs in check, and improves business results. It's hard to "see" technology, but you can tell when it's working. There are three essential technologies: algorithms, workflow, and analytics. Extensive use of algorithms and rules drives billing efficiency while intelligent workflows optimize people resources. Analytics technology helps deliver "lessons learned" back to the practice to drive better results.

High-Tech, High-Touch, High-Value Service
Choosing the right billing partner will help care providers gain the insight they need to continually sharpen their business for better care, better service, and better results. Local billers offer the best of all worlds, offering a high-tech, high-touch, and high-value alternative to national billing firms. Health care professionals can rely on their local billers in the same way they would a trusted advisor. With their proximity and close relationships to their provider clients, local billers offer a potentially huge advantage over the enterprise-centric IDN and mass-market national billers.

Billing data can no longer be considered mundane and an administrative headache. Instead, it should be viewed as a potential wellspring of information, which elevates it from the mundane to the strategic, a resource that has become a competitive weapon.

— Rich Papperman is CEO of New Jersey-based Cape Medical Billing, a premier medical billing service for physicians, physical/occupational therapists, and ambulance companies.