In the current climate of decreasing reimbursement and increasing utilization rates, securing the proper reimbursement is critical. While in-house billing duties are still common among radiology practices, dedicated billing companies are becoming a common and viable option as well. And with an expansive and professional staff, most of these companies are capable of more accurate and thorough billing capabilities. When Advanced Berkshire Medical Imaging opened in 2003 in Berkshire, Mass, using a billing company seemed like the best course of action to its president, Prakash Malkani, MD, who had previously worked at a facility that took care of its own billing needs.
“We were a brand-new practice,” said Malkani. “We had plenty of other things on our plate to set up this practice—recruiting radiologists and providing good service—so we did not have time or capabilities to do in-house billing.”
At Malkani’s previous position, he had his billing manager run an analysis of the costs of in-house billing, which found a 12% to 14% overhead for doing billing. When Advanced Berkshire Medical Imaging opened, Malkani knew that it would be better to outsource the billing aspect of the practice rather than keep those responsibilities in-house.
Two years ago, however, in the middle of declining revenue, Malkani asked the practice’s billing provider to analyze the group’s financials and compare them to similar-sized practices in the area.
“I asked them, ‘How are we doing vis-a-vis other radiology groups in the state in terms of reimbursement from insurance companies?'” said Malkani. “They said, ‘We don’t know because we don’t have your fee schedule.’ I said, ‘Aren’t you supposed to?’ They said they needed me to get them the fee schedule, which we did, no problem. Then they compared it, and we realized that we were being paid 20% to 30% less than other radiology groups that they themselves have.”
At that point, Malkani knew it was time for a change, but the facility was tied into a contract with their billing provider until February of this year. During 2011, the radiology group interviewed a number of billing partners and decided to use Atlanta-based Medical Management Professionals (MMP).
“When we first met with MMP, I was blown away by how knowledgeable and organized they were,” said Malkani. “The questions that they asked were so pertinent: How are you managing your fee schedule?”
Although Advanced Berkshire Medical Imaging was still under contract with its previous billing provider, in October 2011, MMP began contacting insurance companies in order to ease the transition. For a company that promises a 5% to 8% increase in revenue for new customers, a smooth transition is a must.
“I was concerned that if we switch over, we were going to have a major loss for the first year in transition because the other company is winding down and this one is taking over,” Malkani said. “But both companies were so professional during the transition that we have not experienced any negatives.”
And the results have been nothing but positive for the radiology group. Malkani raves about the company’s ability to perform advanced analysis to give Advanced Berkshire Medical Imaging a perspective of the industry in addition to increasing the group’s revenue in the short time that MMP has held billing responsibilities.
With this much experience with billing companies—both good and bad—Malkani has a unique perspective on the selection process. His advice is simple enough: make a list of your needs, interview two or three people, ask questions, and see who gives you the best fit for your needs. Perhaps most importantly, if you currently have a billing provider, don’t be afraid to switch if something is not working.
“If you’re a radiologist, do radiology and don’t try to be an internist,” said Malkani. “We always tell the internist, ‘Don’t try to be a radiologist.’ That applies to this, too. If you’re not an expert in billing, don’t try to do it yourself. I know a lot of old groups that still want to do it themselves because it gives them a sense of control. It’s not worth having control over something that you’re losing money on every month.”
