Accounts receivable management for retina practices is one of the more complex in medicine due to a great extent the extensive use of high-cost biologics. So, it may be worth looking at switching your accounts receivable (AR) management from in-house to a billing service.

What are the motivating factors steering you toward this decision? Among the reasons practices cite are cost savings, challenges with finding and/or retaining qualified staff and a reduction in operational costs.

Questions and Considerations
How much do billing services charge? Generally billing services base their charges on a percent of collections. Be sure to evaluate the service charge on high-cost biologics to ensure you are made whole.

Not all billing services offer the same services, or even the same level of services, so vet them carefully. Since the employees of the billing service will be interacting with your patients, they become a direct extension of your practice. Does the billing service reflect the culture you wish to portray?

Other considerations include:
• Does the service have expertise in retina billing?
• Will it assign staff dedicated to your account?
• Is the service familiar with programs like Good Days or Patient Access Network Foundation/CoreSource and what its role would be in working with these programs?
• Who will obtain prior authorizations: the service or your staff?
• Can the service integrate with your electronic health records (EHR) and/or scheduling programs?
• What about termination? Who keeps the AR and collect-out?
• Will you maintain the ability to continue to audit your AR?
• How will your existing AR be handled?

Personnel Issues
Existing staff may resist the idea of an outside billing service, and management must also get on board to ensure an smooth transition. You will also need to have an internal point person to address myriad needs between the offices—copies of medical records, assistance with appeals, confirmation of treatments and questions or concerns patients may have.

Our practice has considered using a billing service on several occasions.  We have two full-time individuals who handle all aspects of our AR management. To keep up with all the prior authorizations and applications for financial assistance, we determined we would still have to maintain at least a part-time position. When considering all the factors I have outlined here, making a switch was cost-prohibitive for our practice.

Transferring the burden of recruitment, training and retention of quality employees to a billing service can help considerably. This is an important  consideration if your present billing staff consists of one to three employees. You run the risk of losing important institutional knowledge should one of these individuals leave.

Where It Can Make Sense
However, practices in large, metropolitan areas, where salaries and real estate costs are considerably higher, find that switching to a billing service results in significant savings. Don Shay, previously administrator for Retina Consultants of Houston, says, “We can now use the office space that was once occupied by the billing department for other purposes, such as research, diagnostics and exam rooms.”

A billing service may be a great option for a start-up practice, too, because it can provide all the credentialing, contract review and negotiations, fee-ticket creation and integration with scheduling and EHR, thus allowing the doctor to focus on building the clinical aspects of the practice.

Finding Lost Money
Billing services may be able find underpaid claims, charges written off in error or claims that should be appealed or rebilled that otherwise would have been missed. “We manufacture money,” Ryan Patano, vice president of Alta Medical Management, a billing service in Salt Lake City, tells me. “Our job is to get physicians paid more money, more quickly, with higher patient satisfaction.”

Retaining a billing service can reduce your overhead, increase your collections and remove the hassles associated with managing that facet of your practice, but weigh this decision very carefully. Making the initial change can be costly and disruptive. It is not a one size-fits-all proposition.

Mr. Laurita is chief operating offer at Retina Associates of Cleveland. Ms. Rasmussen is administrator at Rocky Mountain Retina Consultants, a six-office practice in four western states with the main office in Salt Lake City.