digital outsourcing
Partnering for better billing
by John Stalnaker

Given the changes in our industry, most providers have been forced to take a deeper look at the way they do business, from the products they supply or are allowed to supply to the referral sources they trust will actually get them documentation.

Providers large and small have made two resounding points over and over. First, most are already understaffed to accommodate the rigorous follow-up necessary to get paid on 20% to 30% of the claims being submitted; and second, the new work-from-home model isn’t helping.

Staffing issues, coupled with the continued reduction in reimbursements, mean that billing and collections need to be analyzed and unnecessary touches eliminated. With the limited tools available to gain visibility into the root cause of a problem, this can be like finding a needle in a haystack. Providers need to examine their current processes and dissect accounts receivable (AR) to try to get every dollar they have contracted for and every rental month accounted for and collected.

What to Improve

To analyze the data effectively, there must be a baseline of the company’s current state, what to improve on, a goal to achieve and how to maintain this goal. Industry averages can be a good start, but every provider is unique in one way or another. The most effective way to do a true comparison is to look at your own historic data and identify areas that need improvement—and then continue to improve. In most cases, providers can identify several areas.

When a company focuses efforts on one aspect of their business, the work created downstream will then require additional resources. For instance, if a provider focuses on getting all of their orders confirmed, the documentation procurement team—and everyone else who follows in the process—will need to keep up. The same is true with a push to work all AR that have aged past 90 days; if everyone is focused on cleaning up the old claims, the pile of new claims continues to grow. This teeter-totter methodology causes tension in the workforce and an unclear sense of how to identify the real issue and fix it.

Here’s the point: As a provider you don’t need to make drastic changes. You just need to concentrate on what you can accommodate without making your staff miserable—and get help with the rest. When providers focus on their core competencies and partner with a company with complementary core competencies, the end result is a more stable, scalable and profitable company.

Outsourcing for Better Results

In a traditional outsourcing model, the provider hands off the back-office billing functions completely and the outsourcing partner takes over the responsibility of working the front-end rejections and AR all the way through payment posting. From my own experience with ACU-Serve, as the company matured and our customers became larger, we soon realized the traditional way of doing business was not a good fit. For us to take over billing for a provider, we would need to backfill anywhere from 25-50 positions within our own staff, while the provider would have to either let some members of their team go or find a way for the organization to absorb them. On our end, we ended up hiring, training and maintaining these positions—which anyone in our industry knows is a daunting task.

Another option is to consider a “rightsourcing” model, where the outsourcing partner and provider manage payers as a team. Start by looking at your historic data and evaluating your strengths and weaknesses across the entire payer mix. This allows your outsourcing partner to identify where they can have the most impact and put a plan together that will allow your staff to focus on the payer or payers you have historically been successful with, leaving the rest for your partner. With a combination of technology and consulting, you can collaboratively work towards a more effective process.

Teamwork in Implementation

There can be a blurred line when it comes to roles and responsibilities, and a gap between actual versus perceived processes. Using strong project management backed with technology, begin your engagement with an outsourcing company with a complete analysis of how a claim moves from the initial referral until the money is deposited. Allow your partner to make recommendations, make sure they are implemented, set attainable goals and get everyone on the same page and working as a team. This model has been proven to work effectively, and allows both companies to work as a team of specialists focusing on their given disciplines.

Rightsourcing works not just because resources are added to an understaffed provider. It works because it provides technology, quantified data and actionable items. Make sure that your partner tracks every interaction their employees have with a claim. You need to know why they touched the claim, what action they performed, what they expect to happen and what actually happened. This data can provide guidance on processes that can cause a delay in payment.

Sometimes all providers need is an extra set of hands to help with the heavy lifting and sometimes they need to call in a specialist to not only help clean up but also to uncover inefficiencies that created the problem in the first place. There are many companies out there with the staff and expertise to help. The data these companies gather along the way allows them to give providers the critical information they need to solve problems and gain efficiencies. Once you solve a problem with a process change, everything downstream is affected.

John Stalnaker is vice president of sales for ACU-Serve Corp, whose core business is outsourced billing coupled with technology. He works with providers to analyze their current workflow and help streamline the insurance billing and collections process. Stalnaker has 20+ years experience focused on consulting and technology with an emphasis on business intelligence and data mining.