Monday, March 8, 2010

Melissa Young, MD: My biller, my husband

After having paid about 10 percent of collections to our billing department when I was at my old group practice, I had to make a decision about who would do the billing for my new practice.

I had found a couple of billing companies that would take less (heck, no one I know has a company that takes 10 percent). But even 5 percent seemed like a lot. And I was pretty jaded after my prior experience. You know there was a time that our collections were way down one month, allegedly because the person responsible for our billing went on vacation and stuffed our billing slips in a drawer instead of delegating them to someone else.

Plus, anything less than $10 was just written off apparently. I know $10 may not seem like much, but let’s say that even two patients a day owed $10, that’s more than $7,000 a year! Now, I understand, if you’re paid hourly, you don’t care if you collect $10 or $10,000, you shuffle your papers and make an occasional call, but if you get a denial, then so be it.
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So, after careful consideration, we (meaning my husband and I) decided that my husband would do my billing. After all, other than me, who else truly has an interest in how much gets collected? Who’s going to look at every claim, every invoice, every EOB? And who’s going to figure, yes, it is worth the 44-cent stamp to send that statement for $2.29.

Now my husband’s not a biller by trade. But he took the requisite courses and is proficient at math, and quite honestly, I think he’s got a little obsessive-compulsive trait in him. This of course is great in a biller. But my husband also has a full-time “real” job, and because of my hours, he is also a very hands-on dad. So he does the billing during his lunch hour (he’s always grateful for the drug rep lunches), in the evenings, and on the weekends.

We had some technical difficulties at first, as he learned the practice management system and our clearinghouse’s software, but he has it down pretty good now. Sure, he gets frustrated at making phone calls to insurance companies, especially when he can’t get a human on the phone (which is all the time), and the phone calls from patients who say they shouldn’t owe anything because they have a secondary insurance (which would have been good to know when they came for their visit).

But he says, strangely enough, that he kind of likes doing my billing, and I like having him come to the office everyday. And if the time ever comes that the world doesn’t need engineers, he has something to fall back on.


  1. Dr. Young,

    Your frustrations are the very reasons I started my own billing business. As a medical management consultant, I saw many practices who were doing it poorly in-house, or who had outsourced the billing to a third party that just didn't care enough and also did it poorly. And all the while, those ineffective billers were charging the physicians an exorbitant amount.

    I was sure that I could do it better, and sure I could do it cheaper. Plus, to ensure client satisfaction, I made sure that providers had online access to our progress every day (so that all our activity is visible, and no one can stuff superbills in a drawer unnoticed). Furthermore, we are located in New Jersey, a state that regulates medical billing companies, and we are fully compliant.

    I applaud your initiative in bringing your billing in-house. But for many practices this is not an alternative. And those practices must take all steps necessary to ensure they are dealing with a billing company that represents the physician's best interest, and the best interest of her patients.

    Thank you for sharing your story.

    Yossi Faber
    President, Clean Bill of Health

  2. I do the billing for my husband's office(3 doctors)and she's right--no one has more of a vested interest in the practice doing well than a spouse. Our A/R is 32 days & the benchmark is 45 days. Our collection ratio is 99% with gross revenues of $2.3 mil. Our fees are not high so we don't write off $3.00 balances and we contest every ins. denial and rarely lose.The practice has a family atmosphere and patients bring us food.

  3. i do the billing for my husband and his 4 associates. have been doing it for 24 years.
    you are right in saying nobody does it better than one who has a vested interest. I don't let anything slip by me. His associates love it because they know they can trust me as they have colleagues that have been "taken" by their billers/office managers, one to the tune of $500,000 over 13 years! Yes we need applause!!

  4. Yes, I had heard horror stories of office managers stealing, and all the different and creative ways they do it.
    So far, so good as far as time to collection and our denial rate. And so far, no bounced checks either.

  5. My view is different, I don't think spouses should work in the office. Spouses in the office are way too prevalent in health care, they cause too much interference. I know this statement will upset a lot of people but, I know more will agree with me. There are trustworthy people that you can hire, you just have to be careful and intuitive in your choices.
    I for one have never stolen or worked with anyone who has stolen but I have heard the same stories. Once again, I think good people are out there, you just need to find them.

  6. I agree with "Anonymous..." that having a spouse in the office is not the best idea for a variety of reasons. And if the husband already has a full time job and is a hands-on dad, when will he have time to give this 100%. It may seem okay at first, but as rejections and statements pile up, it could get away from him. Embezzlement is rare, just keep the safeguards in your process.

  7. All good points. I don't mean to suggest that an in-house biller has to be a spouse because everybody else would steal. heck, a spouse could steal, too, couldn't he/she? And I am sure that there are hard-working dedicated non-spouses who would do a wonderful job.

    And I do agree, that having a spouse/brother/cousin working in the office can be a problem for some practices. We try to make it clear that he is not the manager, he is not involved in other aspects of the practice, and he stays out of the staff's way. I have been to practices where the spouses is the office manager and I find it very uncomfortable.

    And as far as how hubby can give 100%? We both realize that this may not last forever. I ask him frequently whether it is too much for him, or whether we should outsource. At the moment he is doing a bang-up job and he likes it, so we'll leave it be. he has started delegating some tasks to my administrative assistant whom I see as being a potential manager one day.

  8. I also agree with anonymous. This is such a hot topic in healthcare. I have worked in several offices in which the spouse is involved in billing, male and female. What a nightmare! Even though they have taken "courses" they never seem to get the concept of what they are doing and the ones I have worked with have done it for years. The problem is they are the doctors wife or husband and the person who works closely with them, the biller, or office manager cannot say anything about how things are posted incorrectly because they get mad and they are the spouse of the doctor and they can do no wrong. It is a mess! I agree spouses should stay at home.

  9. Just as important is the Front desk staff. Insurance eligibility, and benefits should be done before the patient encounter at the front end. This allows the biller to follow up on claims that are aging, or denied at the back end of the flow.


  10. The bigger trouble with spouses as office manager is that it often makes the staff feel trapped. After all, who are they to complain to about how the doctor or the manager treats them?