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Models Of Billing. Pros and Cons.


When deciding on a billing company there are quite a few factors: cost, communication, and reputation. But one area of a billing company that has gotten less criticism in the past is the structure and processes of a billing company.

We are going to describe three models of billing and their pros and cons. These models can be incredibly efficient and cost effective if implemented correctly.

1. The Traditional Model

Traditional models of a billing company have a clear path for submitting claims and communicating with the provider. Typically the billing company has a software they use and gain all the information they need to submit and follow-up on claims from a superbill. The therapist will submit the superbill to the biller and the biller will submit claims, follow-up, and report to the provider.

PROS:

Billing is completely off your plate, and there is no need to be reminded of what is happening.

Money appears in your bank account with minimal effort.

No assumed risk of personnel

CONS:

Claims can be missed in the process. (Practice Solutions has found an average of $2,000.00 of unsubmitted claims from providers who use this model.

Increase liability of claim fraud

Transparency issues. You don't know where rejected claims are in the process.

Companies with this model typically have to charge more because of the higher overhead costs.

2. The Shared Model

This model is relatively new to the market. This model has therapists and billers share a portal via a software. This allows for complete transparency of where claims are in the process. This model also helps with year end and quarterly taxes because the therapist can pull financial reports easily. Whenever a session is completed, this triggers a claim to be sent to the clearinghouse. If it is rejected, there is a notification within the system, and the claim is pursued.

PROS:

Affordable. The billing companies compatible with this model can be fairly cost-effective.

Accountable. Billing companies can't hide from not submitting claims.

Limited Liability. Companies who use this model tend to know if services were actually rendered.

CON:

Software requirement. Some providers don't like being required to learn a software.

Claim submission fee. Frequently this model will incure a claim submission fee.

Communication. Since billers are remote contacting them can be a challenge.

3. The In-House Model

The last model is where the biller is in the provider's office. This person or team of people is on payroll as employees. The practice will use a shared software and the software communicates when a claim is submitted. Claims resolution happens fairly quickly because the providers and billers are in the same building.

PROS:

Ready access to the staff billers.

Communication happens in real-time.

Context. Billers and providers have a professional history in which to build strong working relationships.

CONS:

Increased Overhead Expenses.

Space is required for your billers.

Equipment Costs Increase.

CONCLUSION

There are many avenues in which a provider can go in regard to billing. However, don't let the model of billing be a hindrance to your business. At the end of the day, whichever model is efficient and cost-effective for your practice is the one you should go with.

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