It is important to consider billing models for internal medicine clinics with multiple doctors to ensure that reimbursement is optimized, denials are minimized, and administrative workflows are optimized. Within this context, billing services are influenced by the number of doctors, payer contracts, and the complexity of coding. Therefore, the choice of medical billing services is crucial to the overall performance of the revenue cycle.
Billing Models for Multi-Doctor Clinics
Typically, multi-physician practices have three primary options for billing:
- In-house billing
- Outsourced billing
- Hybrid billing
Each option has a different structure, sets of responsibilities, and different financial considerations.
1. In-house Billing
In this case, the clinic does the billing themselves, including charge entry, coding, submission to payers, posting payments, and follow-up. Clinical practices rely on a considerable number of trained personnel and sophisticated medical billing services software to manage revenue cycle processes on a daily basis.
Benefits
- Control and oversight
- Provider and billing staff communication is instantaneous
- Customized workflow
Challenges
- High operational costs
- Staffing, training, and regulatory compliance
- Billing technology
- Possibly insufficient advanced services for billing and denial management
Performing revenue cycle activities on a daily basis for multiple providers can be a challenge for larger clinics.
2. Outsourced Billing Model
A lot of developing practices prefer outsourcing part of their medical billing services to specialized medical billing companies. These services include eligibility, claim submission, and denial management.
Some of the advantages of outsourcing medical billing services include:
- Expertise in billing from certified professionals
- Less overhead in staffing and training
- Better management of claim denials
- Increased compliance with payer regulations
- Solutions to staffing concerns for growing practices
Provided analytics and automation to reduce reporting, and increase billing collections is a norm with outsourcing. Vendors working with clinics in large systems may provide hospital-level medical billing service expertise, which is advantageous for complicated cases in internal medicine.
From a cost control perspective, medical billing services are cost as a percentage of collections which is predictable and based on attained results.
3. Hybrid Billing Model
In the hybrid model, there is internal billing and external billing. For example, the clinic may do the front-office activities like scheduling while the back office services like claim submission and denial follow-ups are outsourced.
This model is ideal for practices wanting:
- Billing transparency
- Reduced administrative workload
- Targeted support for accounts receivable (AR) recovery
- Controlled cost flexibility
More control of the operation by the clinic while the control is provided through specialization is the reason for increased popularity of hybrid Billing.
Key Considerations When Choosing the Most Suitable Model
With regards to multi-doctor internal medicine clinics, the optimal billing model will depend upon several considerations including:
- Size of practice and volume of patients
- Complexity of payer mix
- Internal administrative capacity
- Technological capacity
- Plans for growth
Clinics with high patient volume and low administrative capacity, tend to benefit the most from outsourcing their medical billing services. On the contrary, larger, more established practices with proficient billing staff may benefit from having their in-house billing operations and medical billing services software.
Conclusion
Most multi-doctor internal medicine clinics will find that billing either in-house, or a combination of in-house and outsourcing, provides the best combination of efficiency, compliance, and maximization of revenue. Medical billing services for provider groups come with the added value of ensuring proper coding, claim management, and payer negotiation which is an area of revenue leakage.
The best billing model is the one that Clinician’s claim that administrative billing work is minimal, and patient billing collections are maximized, and the internal administrative work is minimal billing model to enable Clinician’s to concentrate on quality patient care rather than managing billing, collections, and compliance issues.