Dr. John woke up at two AM and was unable to fall asleep again. He went to his desk, logged onto his computer and looked for the termination clause in the Agreement with his billing service. Dr. John still had fresh memories of meeting the billing services' President, who seemed both competent and pleasant to work with. She showed good references, had a great service attitude, and even agreed to reduce her price. As he recalled these promising signs, Dr. John then wondered why were her collections so low for the past six months?

Typical debates, in the risk-benefit analysis of whether to outsource medical billing, invoke five kinds of argument: balance sheet, performance, control, focus, and zero-sum game. The debate then boils down to a checklist of a dozen steps for vendor selection. Nevertheless, it is often the case that even the most accommodating service, which passed the most stringent scrutiny, fails to meet the simple billing needs of a small and seemingly easy to serve practice. The question then becomes, what defines a reliable set of criteria for selecting a good medical billing service?

The answer seems to be far more related to the business culture differences between the practice and the service than to the specific capabilities of the given service. Gerber's E-Myth theory applies well to both managing medical practice and billing; a good doctor does not necessarily make a successful practice owner and a good biller does not always develop a profitable and growing billing service. In fact most medical practices as well as billing services struggle and often fail because the founders are "technicians" who are inspired to start a business without business management skills and without knowledge of how successful businesses run.

In Gerber's vernacular, doctors are "technicians" skilled at healing people while billing "technicians" are skilled at billing and may enjoy coding. So, when "technicians" start their own billing operation, they continue doing the work they are skilled at, and, without access to solid technology and industrial-grade processes, soon find themselves unable to scale up. Rather than working "on" the business, they work "in" the business. In other words, they simply own a job instead of a business. A scalable practice just like a scalable billing service requires disciplined performance measurement, process consistency, industrial-grade technology, and the discipline for systematic and continuous improvement.

If both the client (chiropractic clinic or medical office) and the vendor share the culture and the discipline for systematic and continuous improvement, then the billing service will be perceived as successful. A shared discipline will help to pursue shared goals to build consistent and scalable services for patients and for medical practices respectively. If, on the other hand, only one of the participants has a process to scale up systematically, while the other is managing the practice or the service in an ad hoc manner, then a conflict is inevitable. Since the billing process involves humans (who err), and payers (who delay, underpay, and return for audits), then every, even the best-organized billing service, will face delays and underpayments. The strength of a billing service must be tested in terms of its processes and technology to discover problems and improve the solutions. If the billing service has no such processes, it fails. If the billing service has such processes but the client practice has no appreciation or discipline to work together on establishing practice workflow processes, the billing service fails as well. Finally, if neither of the participants in the billing service relationship cares about consistency and scalability, then results are entirely unpredictable and potentially risky for both not only in terms of lost revenue but also in terms of potential fraud and compliance problems, audits, and associated penalties.

So, what's Dr. John to do next time he is in the market for a billing service? In-source? Outsource? These are not the right questions he must ask himself. The right questions to ask are: Do I want to build a scalable and consistent service for my patients? If so, what are the key components in my practice and how do I make each one of them consistent and scalable?

Know any health care providers who complain about shrinking insurance payments and increasing audit risk? Help them learn winning Internet strategies for the modern payer-provider conflict by steering them to www.BillingDynamix.com - Billing Service and Practice Management Software for Physical Therapy and Rehab Offices, home of Practicing Profitability - Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices: Collections, Audit Risk, SOAP Notes, Scheduling, Care Plans, and Coding"book by Yuval Lirov, PhD and inventor of patents in artificial intelligence and computer security.

Article Source: http://EzineArticles.com/?expert=Yuval_Lirov
http://EzineArticles.com/?Medical-Billing-Outsourcing---E-Myth-Lesson-in-Cultural-Gap-Discovery&id=800856

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