11 major doctor office challenges to retain in house billers[Infographics]




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It is past seven in the evening. I have 15 minutes to kill before my cab. As I casually browse through blogs I chance upon the survey results of Black Book. The study reveals that 54% of healthcare CFOs believe outsourcing will help them improve their financial health. And that the outsourced RCM market is growing at a startling 27% rate. There are a lot of reasons behind this trend. But the decision to outsource almost always boils down to one person- the medical biller. From my eight years of working as a medical biller I’ve heard several reasons for medical practices to make the switch. From the funny, “my biller took too many loo breaks”, to the usual, “he moved out of town”, I’ve heard them all.

Here are 11 major reasons why medical practices outsource their RCM to vendors:

Reason 1: Left me at short notice

One of my senior billers informed me that she would be covered under her partner’s insurance plan and demanded a 30% hike as I wouldn’t be paying her premiums anymore. I explained to her that the practice was going through a financial rough patch. Next week she informed that she’d be leaving and gave a generous one week notice period. Not a very pleasant experience”

fumed one of our clients, a practice manager of an orthopedic centre based in Florida.

An increasing number of physicians are complaining about in-house medical billers quitting at short notice. The reasons are myriad, work pressure and monetary reasons top the list. Medical billers quitting can be truly catastrophic for medical practices. The struggle to find the right biller as medical claims pile up is a growing nightmare amongst healthcare professionals. To find the right biller can take anywhere between a week to a month’s time. And claims languishing all that while, means the next medical biller who steps in will be snowed under with work.

The aforementioned orthopedic centre had an average of 30 patient visits per day. They submitted claims every 7 days. We started working with the practice 3 weeks after their previous biller left. The average value of each claim was $120. This meant we had to work on pending claims worth $7200 right at the outset. Definitely not an enviable task!

Reason 2: Unable to find a biller who can work with my EHR

EHRs are a vital cog in the RCM wheel. Working with a medical biller who is not comfortable with the EHR used by a healthcare organization is just the perfect recipe for disaster. Finding an in-house medical biller who can work efficiently with the EHR/PMS the medical practice uses is incredibly difficult. A survey conducted by WANTED analytics says that all the ads posted for healthcare professionals specified that the job applicant must be proficient with EHRs.

There is a huge demand for EHR focused in-house medical billers but the supply is low.

I made a bad choice a few years. I chose an EHR that was rigid, convoluted and expensive. I switched to a free, cloud based EHR because it offered more flexibility and though bare-boned helped me cut back on costs and work more efficiently. But sadly enough my billing team of 4 found it difficult to adapt to my new system. 2 quit and I moved the other 2 billers to my pay-roll and accounting division and outsourced the billing tasks to a medical billing company. It’s worked for all of us”

said a practice manager I met on a medical billing conference. Most in-house billers are proficient in working with only one type of EHR unlike billers of medical billing companies who work with several clients and EHRs. Know more about the benefits of in-house medical billing versus outsourcing

Reason 3: My biller is not tech-savvy enough

I remember explaining to my biller about the eBO system of eClinicalWorks only to be met with a blank stare. She found it mind-bending to handle simple tasks such as collecting reports or generating one. And I needed financial reports to take key decisions. A medical biller who could work with my EHR and the slew of revenue management tools my practice uses was difficult to find as most medical billers I met weren’t tech savvy”

complained Elisa Sahner the manager of a dermatology clinic, when I asked her why she was making the switch.

A lot many managers like Elisa find training medical billers on EHRs and tools strenuous and time-consuming.

Download your free copy of the financial decision making process template from BillingParadise

Reason 4: I cannot afford to hire one

Experienced medical billers are expensive to hire. Payroll expenses, benefits, premiums, 401k, training costs and the expensive price tag billing software comes with are burning a huge hole in the pockets of medical practices that are struggling to contain operational expenditure.

As the revenue cycle of healthcare organizations becomes more convoluted it’s become essential that healthcare institutions hire 1 in-house medical biller for every 4 doctors. Small practices do not have the revenue to increase headcount. A single medical biller often doubles up as a biller, coder, AR caller and denial manager to cut back on expenses. With the increased demand for more efficient billing processes and documentation, having a single biller on-board isn’t going to help. Outsourcing is a much more affordable option for practices on a tight budget.

Reason 5: My biller of 17 years is retiring

I still remember the anguish in a medical practice owner’s voice when he spoke about his trusted biller retiring. “Mike understood me completely. He kept the practice financially strong for 17 odd years”, he reminisced fondly. When an in-house biller retires it has an undeniable impact across the entire billing cycle. After working with a, medical billers/billers for several years it is undoubtedly painful to find another biller who can adapt to the workflow of a medical practice.

Billers retiring early or preferring to switch careers is one of the most common reasons my clients state when asked why they prefer outsourcing.

Reason 6: My biller is uncomfortable coding

There was a time not very long ago when medical billing and coding were lumped together and performed as one task. Not anymore. ICD-10 and revised coding regulations demand advanced coding skills and expertise. Most in-house medical billers refuse to handle coding tasks as they lack the training or expertise in it.

In recent years the government has penalized medical practices for fraud and waste and inaccurate or fraudulent coding will result in heavy fines or imprisonment. Every regulation, every act and every reform is centred on one thing- accuracy of medical documentation. Only a certified and experienced medical coder who can work with EHRs to build preference lists and smart phrases and know the features and workarounds of EHRs can help healthcare organizations gain a higher ROI.

I realized that there were more coding related denials after I was forced to double up as a coder, I’m relieved to be focusing on my job alone now”

Steve, the medical biller at an orthopaedic practice told me the other day. We handle the medical coding tasks of the ortho practice and needless to say, Steve is one happy man!

Download your free copy of the denial management whitepaper from BillingParadise

Reason 7: I need a specialty specific biller

Specialty focused medical billers are the need of the hour. A biller who is not familiar with the medical terminology or billing regulations of a particular specialty can feel like a fish out of water. And no prizes for guessing the impact it can have on the net collections of a medical practice. The efficiency and specialty-specific reimbursement insights brought to the table by a medical biller who’s worked for your specialty can translate into bottom-line benefits.

An increasing number of medical practices feel having their services billed by a specialty-focused biller eliminates denials. The biller would also be able to submit charges based on contractual industry standards.

Despite the high demand for specialty specific billers they continue to be a rare species.

Reason 8: I want a full time biller

“Maybe it was just my organization that was unlucky”, rued one of my clients a cardiologist in the sleepy town of Arizona. “Most billers who walked in for an interview wanted four hour shifts or flexible work timings. I couldn’t afford that”. Off late, I’ve been hearing complaints of medical billers who want to work just part time a lot. And this’s another major problem faced by healthcare institutions who work with in-house billers.

Reason 9: Biller couldn’t negotiate better contracts

I was repeatedly requesting my biller to negotiate contracts with payers. As a multi-specialty hospital my payer matrix is quite complicated. I felt we could definitely improve our collection percentage by negotiating better contracts. My previous biller was more than happy with boilerplate contracts and that put my practice at a serious disadvantage”

complained one of my long-time clients, a dermatologist based in Oklahoma.

Reason 10: My biller demanded to be paid extra for AR calling

Martha Gilmore is one of my favourite clients and a great friend as well. When our client support executive asked her why she wanted to work with us, for a survey conducted by our marketing team she cited poor AR follow-up by her previous billers as the reason.

I’ve had 3 different billing teams, before deciding to outsource my medical billing. But none of them were willing to handle AR calling. They found long wait times and endless follow-ups with insurers tiresome. One biller demanded extra dollars for AR follow-ups and the amount he asked was way beyond my budget she said”

Thanks for reading this far. This blog is not by any chance a rant against in-house medical billers. I share a great rapport with many of them. We work together to create a better financial future for the organizations we work with and there have been no skirmishes insofar. Touchwood. I wrote this blog to share my conversations and experiences.

Reason 11: I couldn’t afford the training costs

The post-reform healthcare space is ridden with challenges. One of the major problems cash-strapped medical practices face today is training medical billers and coders. Training costs have escalated over the years and are placing a financial strain on healthcare organizations. The loss of productivity further compounds the problem.

Here’s a simple calculation:

Each full time medical coder spends approximately 1700 hours per year on actual coding tasks (excluding the time taken to abstract charts, scrub codes etc.)

Extensive training for complying with industry standards will take more than 500 hours of training per year

This means a 30% drop in productivity. Medical practices work with off-site billers and coders to avoid loss of productivity, reduce training costs and increase bottom-line benefits.

Click on the Image below to Enlarge:Inhouse billers infographics


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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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