RE: Billing In-house or Out Sourced

[Guest guest]

BI,

Keep it in house. Who is more interested in collecting ALL your fees than

you?

Joe Ruzich, PT

Pueblo, CO

_____

From: PTManager [mailto:PTManager ] On Behalf

Of BI Shafer

Sent: Monday, August 28, 2006 1:04 PM

To: PTManager

Subject: Billing In-house or Out Sourced

Our clinics are based in So Cal and we are currently doing our billing

in-house. I was hoping to get some opinions from others and their thoughts

of one or the other and why. If anyone has any referrals they feel

confident in passing along that would be appreciated as well.

BI Shafer, PT

Southern California

[Guest guest]

BI Shafer:

There are a lot of pros and cons in doing outsourcing.

I can only say that it depends what your ultimate goal is in obtaining an

outside service.

A billing service will do the data entry, posting of payments, adjustments,

statements, they can handle your outstanding accounts, some will do the

collections and legal work. All this depends on what the billing service is

willing to do. Some will just verify your insurance benefits. What it is they

can handle all your insurance billing department.

Their fees will vary depending how much they will do - from 7 - 10% of your

collections.

If you are interested in someone doing this kind of work. Let me know how

many offices and how much work you are interested in releasing from your staff.

Either way hope it works out for you and that I have answered any of your

questions.

CJ

So Cal

[Guest guest]

On the flip side of that, the PT is rarely doing the billing and collections. So

who has a vested interest in getting a claim paid? An employee paid by the hour

who gets a paycheck no matter what-- even if the claim is denied? Or a

competent, specialized billing company that gets paid only if you do? There are,

of course, pros and cons to in-house and outsourced. This brings to mind an

article that appeared in Advance for Rehabilitation Directors that appeared in

May 2005. The link is

http://rehabilitation-director.advanceweb.com/common/EditorialSearch/AViewer.asp\

x?AN=DR_05may1_drp13.html & AD=05-01-2005

Robin L. Roach, CMRS

CEO

Health Data Solutions, Inc.

ton, WV

www.ptbiller.com

Joe Ruzich wrote: BI,

Keep it in house. Who is more interested in collecting ALL your fees than

you?

Joe Ruzich, PT

Pueblo, CO

_____

From: PTManager [mailto:PTManager ] On Behalf

Of BI Shafer

Sent: Monday, August 28, 2006 1:04 PM

To: PTManager

Subject: Billing In-house or Out Sourced

Our clinics are based in So Cal and we are currently doing our billing

in-house. I was hoping to get some opinions from others and their thoughts

of one or the other and why. If anyone has any referrals they feel

confident in passing along that would be appreciated as well.

BI Shafer, PT

Southern California

[Guest guest]

I outsourced when I was new in indepenedent practice as I had soooooo many

things to learn, networks to join, etc. I looked at every EOB that came in and

learned the nuts and bolts of HCFA forms, what CPT codes were reimbursed,

denied, etc. I stayed with the outsource company for four years until we

brought it in-house and our collections shot through the roof!

It's a simple matter, really. Let's say you get reimbursed $40 for a certain

CPT code and you are paying a billing company 8% of collected. Well, that's

$3.20 in their pocket. If a CPT code is denied do you think they are going to

kill themselves over that $3.20? No, they are just inputing the data and

collecting what comes back, it's not worth the fight for them. However, that

denied claim just cost you $36.80 If you don't think that you get quite a few

of those situations then I suggest that you take a long hard look at your EOB's

everyday. I know we have denials for duplicate charges, etc. (Yes, we use

modifiers but it still happens quite a bit)

I would suggest outsourcing to a therapist that's new in independent practice

but once you get your feet wet then I would bring it in-house. Of course, there

is always exceptions, I have heard that Jim Hall does a great job and that he is

diligent, but, let's face it, not everyone is like that. My billing company

wasn't!

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Kiln and Bay St. Louis, Mississippi

GO CYCLONES, BEAT THE HAWKEYES!

Billing In-house or Out Sourced

Our clinics are based in So Cal and we are currently doing our billing

in-house. I was hoping to get some opinions from others and their thoughts

of one or the other and why. If anyone has any referrals they feel

confident in passing along that would be appreciated as well.

BI Shafer, PT

Southern California

[Guest guest]

I agree to keep it in-house. I've done both, and it's a big chore to get the

out sourced company to collect the moneys owed to you. It's so much easier to do

it in-house. When we out sourced, we had alot of accounts past due by more than

120 days. Within 3 months of doing it ourself in-house, all our accounts were

only 0-60 days.

E. , DPT

Bodyscape Integrative Physical Therapy

Pasadena, CA

From: Joe Ruzich

To: PTManager

Date: Tue, 29 Aug 2006 12:42:44 -0600

Subject: RE: Billing In-house or Out Sourced

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<p>BI,<br>

Keep it in house. Who is more interested in collecting ALL your fees than<br>

you?<br>

<br>

Joe Ruzich, PT<br>

Pueblo, CO<br>

<br>

_____ <br>

<br>

From: <a

href= " mailto:PTManager%40yahoogroups.com " >PTManager@yahoogrou<wbr>ps.com</a>

[mailto:<a

href= " mailto:PTManager%40yahoogroups.com " >PTManager@yahoogrou<wbr>ps.com</a>] On

Behalf<br>

Of BI Shafer<br>

Sent: Monday, August 28, 2006 1:04 PM<br>

To: <a

href= " mailto:PTManager%40yahoogroups.com " >PTManager@yahoogrou<wbr>ps.com</a><br>

Subject: Billing In-house or Out Sourced<br>

<br>

Our clinics are based in So Cal and we are currently doing our billing <br>

in-house. I was hoping to get some opinions from others and their thoughts <br>

of one or the other and why. If anyone has any referrals they feel <br>

confident in passing along that would be appreciated as well.<br>

<br>

BI Shafer, PT<br>

Southern California<br>

<br>

[Guest guest]

To all;

This is a chicken vs. egg arguement (which came first)? Points can be made

either way. I can tell you that I worked for therapy chains for many years and

I am not going to surprise anyone by saying that the one thing I learned

during my external audits, internal audits, due diligence work (work related to

purchasing clinics for the company I worked for) and business office

oversight-therapists are trained on how to treat patients. The one HUGE gap

that STILL

exists in Therapy coursework is financial, accounting, management and marketing

training courses. Does this mean that therapists cannot adjust and

accomodate these functions in house? NO. Does it mean they know how to handle

these

functions if they are in house? NO.

Each practice' needs will vary depending on their time, effort, abilities,

etc. I have had companies come to me when they first open and work with me to

get started. After a while, they decide to move their billing in house because

they look at the total amount they pay our company each month and decide they

would rather bring it in house. Other companies grow to a size and decide

they are tired of the training, maintenance and everything associated with the

billing and decide to outsource to a company like ours (i.e., the absolute

reverse of the first example).

An excellant point was made about an outsource company spending a bunch of

time appealing a $40 claim based upon the fact that they are only going to be

paid $3.20 to do the appeal. I gaurantee that is an issue for both in house and

out house..., er, outsource people. You have a limited amount of time in

your day and you need to keep your focus on the most important dollars you can

collect. A lot of times this will not include a $40 item that requires a 1 hour

appeal letter.

Each and every one reading this message would need to examine their own

particular case and decide what works best for them. I know that many of my

clients are happy with the job we do and many aren't. The question always comes

back to the expectation of the service that is being provided along with the

cost

of the service. I have clients that have left (or we terminated their

contract) because we wouldn't do their medical appeals. Since I am not a

medical

person, I write in my agreements that we will handle financial appeals, but it

is our client's responsibility to handle the medical appeal. I could promise

any therapy company anything they wanted to hear in order to get them to sign

on the dotted line. However, it is important to do what you do best and try to

do the job God created you to do. It is up to each of us individually to

decide what God created us to do and decide what that means for you and your

company.

So, if billing is not your strong point and you are unable to find someone to

bill for you locally, then it is probably in your best interest to outsource.

One final comment-many companies swear that outsourcing is a bad idea. Their

outsource experience was bad and that is the source of their opinion. Their

opinion might be 100% valid, but it is steeped on that one company's

performance. A little over a year ago I had a practice come to me on their last

leg.

They were using an outsource company that wasn't able to collect for them.

They were hesitant to sign up with us because our fees were higher than the

company they were using. They told me that they were choking on the price tag

and

were having a hard time signing the agreement. After they signed on, they

found out that our service was paid for based upon the increased collections we

were bringing in for them-actually we have almost doubled what their previous

company was collecting. The owner was grateful because he was able to pay

himself what he thought he was worth and was able to start making double

mortgage

payments every month. Does that mean that our company is great and deserves

to be put on a pedestal? Maybe in that clinic's eye, but in another case

someone might look at the same data and say our performance sucks. My point is

that your opinion will be dictated based upon your experience.

Just a few ramblings for a Wednesday night-I think I will hit the hay now,

since tomorrow is the beginning of football season here in Iowa-Go Cyclones and

Panthers!

Jim Hall, CPA <///>

[Guest guest]

This is a hot issue for many offices. I've seen it work both ways.

Interestingly the PT Benchmark studies I run have shown a consistent

improvement to profit when people out-source.

When looking at the median data, this year's study shows that people who

outsourced (n=18) charged about $25 more per visit, collected $6 more per

visit and paid less office wages. So, even after deducting an 8% fee

(common fees range from 6% to 10%, I used 8% for the calculations) the

practice would have made an additional $166 for every 1,000 visits (actually

more since I did not include the savings from postage, paper, forms, and

other office supplies or phone usage in the calculation). When looking at

the data minimum's there was an even larger profit improvement of over

$12,000 per every 1,000 visits. The data averages showed a $3,500 profit

improvement. The data maximums showed a $16,000 profit improvement.

Obviously, this does not mean that EVERY office that outsourcers will show

these gains, but many will.

To learn more attend my presentation at the PPS Annual Conference in Miami,

FL on Thursday 10/12/06 at 2 pm.

Chuck

R. Felder, PT, SCS, ATC, MBA

HCS Consulting, Inc.

PO Box 9815

Newport Beach, CA 92658

Mobile:

Email: CFelder@...

www.HCSconsulting.com <http://www.hcsconsulting.com/>

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_____

From: PTManager [mailto:PTManager ] On Behalf

Of BI Shafer

Sent: Monday, August 28, 2006 12:04 PM

To: PTManager

Subject: Billing In-house or Out Sourced

Our clinics are based in So Cal and we are currently doing our billing

in-house. I was hoping to get some opinions from others and their thoughts

of one or the other and why. If anyone has any referrals they feel

confident in passing along that would be appreciated as well.

BI Shafer, PT

Southern California

[Guest guest]

Tom Howell makes an excellent point. I forgot how often we had questions

and had to refer them to an outside source.

Matt Capo, PT

Acclerated Physical Therapy and Occupational Health, Inc.

Kiln and Bay St. Louis, Mississippi