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Today, we’re talking about billing companies, specifically medical billing companies, having to use multiple billing systems. Accessing data is a real problem for most billing companies anyways because most systems are not good at reporting at all, and very few systems are good at both billing and reporting. So billing companies have a real challenge finding a sound system at both billing and reporting, and they’re lucky if they get one. Now, they’ve tried out that across multiple systems, and they’ve got an enormous problem.

Billing company issues

Billing companies face a real issue. That is essentially a choice of forcing clients to use their billing software or the billing company using the client’s EMR to do billing. You can imagine billing companies taking on new clients. During that sales process where they’re onboarding the client, the decision has to be made: should you as the billing company use every different client system (you’re using dozens or potentially hundreds of varying EMRs and you’re billing directly out of those systems, so the data all reside in the client system) or do you bill from your system (the client might chart in the EMR or some other type of clinical system, LIS, RIS, etc., and then data gets passed either via transcribing information or interface to a billing system, and you bill out of a centralized billing system)?

The problem is most clients want billing companies to bill out of the client system. The billing company, of course, would instead bill out of their system, in most cases, for a combination of reasons. Although we have seen some billing companies prefer to use clients because they find that it’s less expensive when they don’t have to pay for their system’s seat licenses.

The problem is that billing companies then end up billing out several, or even many, or sometimes dozens of different systems. Even if a billing company has a “main system” that they want to onboard clients onto, they do more than just the billing. Maybe they have to interface to several different systems or something like that for larger clients where they pull data from that EMR and drop it into the billing system. There are still going to be holdouts. There are still going to be clients. Even if they have the philosophy of using their system, there will still be clients who require them to use their system to bill out of.

Data and reporting aspect in billing companies

That raises some real issues for the billing company from a data standpoint and a reporting standpoint. The first, of course, is training on all of those different systems is very hard. Knowing not just how to bill out of them, but knowing the reporting intricacies and how to get the information that you want and all the different ports you have to pull and how to string them all together is complicated. It requires a lot of training, a lot of expertise.

Worse, from a reporting standpoint, many times using templates and other things where once you know what to use, you can do it repeatedly. So if you’ve got one process for your existing system, you have to have a different reporting and analysis process for each system. It becomes a massive amount of infrastructure just for one client or even a few clients on that system.

Most billing systems are just bad at reporting. It makes their lives much more difficult. Sometimes, you have to be a real whiz with that system to get what you want out of it, and it may even be possible. But the likelihood that the billing company will have that level of knowledge about several different systems when it wasn’t their system of choice is extremely unlikely. The impact on providers is significant when billing companies are not adept at using that system for reporting.

It’s not always the fault of the billing company, of course. Clinical workflow typically drives the selection of electronic medical records, not the billing capability and not the reporting or the financial reporting capability of that system. Often, the provider is not only billing the company but is essentially stuck with bad reporting now. The billing company can’t offer good reporting back to the clients if the client system stinks.

There are more issues. The billing company can’t run centralized billing office reports, meaning they can’t aggregate information across all clients and run it across all of those clients. So they really can’t get a good picture of what’s going on in the business across the entire billing company. That means not only are you not able to access trend information like, “Are charges going up?” or “Is accounts receivable going up?”, “Are AR days getting better or worse?” but much more detailed information is not accessible to the client, where having economies of scale is crucial.

You cannot aggregate problems like denials management across the entire company. You need to do that, especially by specialty. So if you’ve got 15-20 orthopedic clients, whether you’re an orthopedic specialty billing company or not. Or maybe, that’s one of the critical things you’re specialized in, and you’ve got several more. You’re a multi-specialty billing company. When you have multiple clients in the same specialty, you want to aggregate all the information for all of those clients into one place to run denials management across all of them.

You need to do problem solving across all of those clients. You really can’t figure out all of those problems unless you aggregate all of that data in one place. You may not know, for example, that Anthem has changed a policy when it comes to something related to implants, or devices, or DME, a particular procedure, or whatever it might be. You can’t see that pattern because the data is fragmented in multiple systems, and you can’t bring it all together.

Data centric revenue

It is a very data-centric business revenue cycle management. If you can’t get all the data together in one place for all of your clients, you’re at a massive disadvantage. If you’re a billing company, think about those things when it comes to you using multiple systems and whether or not you’re willing to use a client system.

We had a policy at the billing company that I started and eventually ran, co-founded, and eventually ran. After the first couple of years, when we used some client systems, we developed a policy that said we would categorically never use a client system. If they want to use their system for clinical, we will either interface or transcribe, but we categorically won’t use their system for billing.

If you are a provider and you’re looking at a billing company, you may want to take this into account, which is you may consider pushing to have somebody use your system because you want to make sure you hang onto all that data. There are ways to maintain that and make sure you continue to have data, access to your data, control of your data, and things like that, and get all of those benefits while not hamstringing the billing company and making them use your system to do the billing where they’re not going to be as adept potentially as using their system. They’re certainly not going to be able to run as much analysis across all of their clients and do that sort of meta-analysis if they use your system. So consider that!


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