New Doctor? You have options

Newly certified doctors are very busy this time of year getting their new practices organized. We thought we’d help lighten the load by explaining the options for handling your medical billing.

Between registering with the CPSO, applying for billing numbers, setting up banking information with the Ministry of Health and registering for MCEDT, it may be the last thing you want to think about, but deciding sooner means getting your first paycheck that much sooner. There are basically three choices to consider and in this blog, we’ll talk about the strengths and weaknesses of each.

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1. Internal Billing Option

Physicians who start working at private clinics or even some hospitals are often happy to see that the clinic handles all billing matters for the doctors. These clinics are often large enough to have billing staff who deal with claims processing, and generally have an infrastructure in place that allows certain aspects of the billing process to be done automatically. For instance, once a physician sees a patient and ‘closes’ the appointment, the claim may be automatically entered for billing so the doctor doesn’t have to write down codes, diagnoses, or submit billing sheets. Therefore, the biggest advantage of this model is that the billing process is partially automated and the physician doesn’t have to worry about billing specifics.

However, there are potential drawbacks as well. First, these clinics often have poor transparency and physicians may not know where they stand when it comes to how much of their billing was paid compared to how much was submitted. Further, we’ve consulted to many clinics like this over the years and the billing staff may be poorly trained or lack expertise. Physicians may appreciate that they don’t explicitly pay for billing services at these clinics, but they also need to keep in mind that part of their overhead expenses paid to the clinic each month are related to OHIP claims processing costs and these costs are not transparent.

2. The DIY Option

For physicians who don’t work at a clinic that handles billing internally, there are two possible approaches. The first is the Do-It-Yourself option. Even just a decade ago, doctors didn’t really have this option. Software was too expensive and cumbersome to use for most hospital-based specialists. But with relatively inexpensive cloud-based billing software, physicians can explore the DIY model. The main advantage of this model is cost. Doctors can submit claims for a fraction of what a billing company would charge. The other advantage is that doctors can log into their accounts and see the status of their claims whenever the urge strikes.

But there are some issues. First and foremost, the DIY option means the physician has to sit down after their shift and enter their data into the computer. They have to contact technical support if there are problems, and physicians need to handle their own errors and reconciliation which often requires a level of discipline, time, and knowledge about the Schedule of Benefits that many doctors do not have. We’ve worked with several physicians over the years who have started as DIYers but after a few months or a year have decided that the hassle wasn’t worth the cost savings. And if a DIYer isn’t following up on errors and rejections properly the result is unpaid claims, negating the economic advantage of this option. It doesn’t take many unpaid claims to cover the cost of having professional billing support.

3. The Outsourcing Option

The second option for those who don’t work in facilities that provide billing services is to outsource. Many physicians and hospital-based specialists end up hiring a billing company to handle their medical billing. These companies vary greatly in size and scope, but what they all have, or should have, is extensive experience with OHIP billing that allows them to capture more of a physician’s revenue than would otherwise be possible.

One advantage of working with a reputable company is peace of mind. Physicians can be confident that they are paid fully for the work they do because good billing companies review all claims with a keen eye to catch missed codes and identify & fix billing errors. Not only does this ensure that doctors don’t miss out on premiums, but it keeps the billing compliant with the rules set out in the Schedule of Benefits in case of audit.

Another advantage is that billing companies handle all the billing tasks that most physicians don’t enjoy very much. For example, good billing companies will track down version codes, contact doctor’s office looking for referral numbers, speak with Ministry staff when problems arise, run outstanding reports, and know how to correct any error. Full service companies will also look after sending private bills when patients don’t have OHIP coverage, and billing out of province and third party insurance claims for you.

The downside, at least on the surface, is that billing companies are more expensive than the DIY options. Most charge a percentage based on paid claims that is generally between 2 to 2.5%, though some companies may have higher or lower rates than this.

Dr DIY – An Example
Let’s say our average DIY doctor starting out captures about $14,700 in paid claims per month, depending on workload and specialty. Using a billing agency would easily increase Dr DIY’s income by $300 or more to $15,000. How? Advice on which codes to bill & additional premiums results in fewer rejections and more revenue, while thorough follow-up ensures each claim with an error is promptly corrected. After factoring in the 2% cost of using the billing agency, Dr DIY ends up getting full service billing for free… and has avoided the hassle of doing their own billing.
Free professional billing services? Not a bad deal.

 

Each physician needs to make their own decision: Are the benefits of outsourcing worth the increased costs? We’re obviously biased here, but we find that the service we provide often pays for itself because the fees we charge our clients are largely offset by the increased revenue and higher capture rate.

If you have any questions about whether your situation may be better suited to either a DIY model or a billing company outsourcing model like JCL, be sure to

Get in Touch!

Want to learn more about outsourcing your billing?

OHIP billing services: A cost-benefit analysis