The Problem

A large multi-site ophthalmology practice in San Francisco, California has determined its billing department is underperforming. Practice needs to determine the efficiency level of its department to determine corrective action or if it should outsource these functions to a professional service.

The Approach

Ben Marcus consulting worked with key stakeholders holders and their support staff to develop a detailed picture of the practice’s current RCM cycle. Staff provided an overview of daily duties and mechanisms utilized to ensure their duties were completed in a timely manner and what level of training each possessed.

Billing data was extracted from the practice’s electronic practice management solution to develop internal benchmarks and provide trending for the previous six years. The practice’s fee schedule was reviewed for errors and completeness, while the scheduling data was reviewed for missed charges.

These data points were utilized to develop a detailed report for the physician partners to review that highlighted the actual performance of the billing staff, holes in workflows that would cause a drop in profitability, and a cost-benefit analysis to model the impact of outsource vs in-office billing.

The Value Provided

Once the assessment was complete, Ben Marcus Consulting developed a detailed report for the physician partners that highlighted:

• Actual performance of the billing staff
• Workflow Inefficiencies
• Missing reconciliation mechanisms
• Suggestions for improvements if billing remains in-office
• Cost-Benefit Analysis of In-Office vs. Outsourced Billing
• Suggestions on what KPIs to track monthly
• Review of underperforming indicators with potential explanation of cause

The practice received an updated fee schedule to bring its standard charges above contracted allowable and in-line with market rates. Using the billing assessment as a starting point, additional areas for improvement further “up the chain” were identified that would help the practice improve its overall performance.

Additionally, the practice was advised on what level of service it could expect from an outsourced billing service at various fee levels, ranging from core RCM functions to a full MSO engagement.