When Your Billing Is Not Under Your Roof: How to Keep Control of Your Revenue

Remember when most medical practices could walk down the hallway and talk directly with the person responsible for billing? Questions about claims, denials, payments, or patient balances could often be answered by simply stopping by someone’s desk.

That is no longer the reality for many practices. Today, billing may be handled by an outside billing company, a centralized corporate department, or employees working remotely.

This is just a “sign of the times,” and of course nothing is wrong with any of these arrangements. In fact, they can create tremendous efficiency, but distance can also create a false sense that someone else is taking care of everything. I say this often, and I believe it applies perfectly here: “No one loves your money like you love your money.” So, whether billing is happening ten feet away or ten states away, the responsibility for understanding the financial health of the practice does not disappear simply because someone else is performing the work. You can delegate billing. You should not delegate awareness.

One of the greatest risks I see in revenue cycle operations is not necessarily poor billing. It is lack of oversight. A practice hires a billing company or assigns billing responsibilities to remote staff. Reports arrive every month. Deposits continue showing up. Everyone assumes things are fine. Until they are not.

Maybe accounts receivable has slowly increased. Maybe certain payers are denying claims at a much higher rate. Maybe claims are not being submitted in a timely manner. Maybe patient balances are sitting untouched. Maybe adjustments are being posted without anyone reviewing why. None of those problems usually happen overnight. They build quietly. That is why billing oversight cannot simply be based on whether money is coming into the bank.

The better question is, are we collecting the money we should be collecting, and do we understand what is happening to the money we are not collecting? Those are two very different questions.

Practice leaders do not need to become professional billers, but they should understand the basic financial indicators of their practice. At a minimum, someone within leadership should routinely review accounts receivable, aging, denial activity, adjustment activity, payment posting, and outstanding patient balances. More importantly, do not simply receive reports, but also understand them.

If your billing company sends a beautiful twenty page report every month but no one in your organization can explain what the numbers mean, the report is not providing much oversight. Ask questions. What changed from last month? Why did it change? What are our largest denial categories? Which payers are creating the greatest delay? What claims are sitting beyond normal follow up timeframes? What is being written off, and why? Good billing partners should welcome those questions.

One area I encourage practices to pay particular attention to is adjustments.

Adjustments are a normal part of revenue cycle operations. Contractual adjustments occur every day, but not every adjustment should quietly disappear into the system without visibility. Practices should understand who has authority to make adjustments, what types of adjustments require approval, and how unusual or significant adjustments are reviewed.

Think about it this way. A claim that was never followed up may eventually become an adjustment. A denial that could have been appealed may eventually become an adjustment, and a patient’s balance that was never pursued may eventually become an adjustment. Once the adjustment occurs, the account may look clean. That does not necessarily mean the revenue cycle worked correctly.

Deposits matter, but deposits are the end result of many processes. A healthy revenue cycle begins much earlier. Was the patient registered correctly? Was insurance verified?

Was the service documented appropriately? Was the claim coded correctly? Was it submitted timely? Was the payer’s response reviewed? Were denials worked?

Was follow up completed?

If you only evaluate the amount deposited into the bank, you may miss breakdowns occurring throughout the process. Revenue cycle oversight should look at both outcomes and processes.

Whether your billers are employees or vendors, expectations, roles, and responsibilities should be clear. Who is responsible for claim submission? Who works denials? How quickly are denials addressed? Who follows up on unpaid claims? Who communicates recurring documentation or coding concerns back to the physicians? When everyone is responsible, sometimes no one is responsible. Defined responsibilities create accountability, and accountability creates visibility.

Remote billing also requires practical operational safeguards, and practices should know exactly who has access to the practice management system, electronic health record, clearinghouse, payer portals, and financial information. Access should be appropriate to the individual’s responsibilities. When employees leave or vendor relationships end, access should be removed promptly. Leadership should also know who controls important credentials and accounts.

You do not want to discover during a transition that your billing company controls the only login to a payer portal, or that no one within the practice knows how to access critical revenue cycle systems. Your vendors may operate the process.

The practice should still maintain ownership and access.

Finally, consider this- You audit clinical documentation, you audit coding, so why wouldn’t you audit your billing? Periodic review of billing activity can identify patterns that monthly reports may not show.

Select a sample of accounts and follow them from the date of service through final payment. Was the claim submitted? Was it accepted? Was it paid correctly?

If it was denied, was the denial appropriate? Was follow up performed? If money was adjusted, was the adjustment reasonable? Sometimes the best way to evaluate a revenue cycle is not through a spreadsheet. It is by following the story of an actual account.

One of the simplest safeguards is also one of the most effective, and that is to meet with the people handling your billing- not only when something is wrong, but to schedule regular conversations about revenue cycle performance. The goal should not be to micromanage the billing process, but rather to remain connected to it.

A great billing company can be an incredible partner, and a strong remote billing team can perform just as effectively as employees sitting inside the practice. The issue is not where billing happens. The issue is whether leadership remains engaged. Trust your team. Trust your vendor, but verify the process, ask questions, review the numbers, understand the trends, monitor the adjustments, audit occasionally, and stay involved.

Regardless of who submits the claims, posts the payments, or works against the denials, the financial health of the practice still belongs to the practice. Remember, “No one loves your money like you do.” So do not set it and forget it. Stay diligent. Stay informed.

And most importantly, stay in control.