Lower Billing Rates Don’t Always Equal Savings

It’s not what billers charge, it’s what they collect that matters

In medical billing, like in most industries, you get what you pay for. Yet, all too often, we hear from independent group practices that have had to endure a now familiar series of events:

  • A billing company gets acquired and/or receives an infusion of capital from private equity
  • These new investors then begin pushing the billing company to sign more clients, even if it means lowering their historical rates
  • And Physician groups get lured by the billing company’s promise of better performance for lower rates
  • In many cases, though, the benefit of a lower rates is negated by the cost of declining billing performance and poor responsiveness costly service failures.

Lower billing rates don’t always equal savings

Client Profile

This independent emergency physician group formed in 2004, when their hospital left its staffing company and began working directly with these local physicians. Because of Brault’s reputation in the emergency medical billing space, practice leaders chose us as their billing services provider. For years, we enjoyed a fruitful and productive relationship, until one day when everything changed.

Business Challenge

Medical coding and billing is a very competitive industry, where providers range widely in experience, service offerings and, of course, price. Practices are frequently lured away from a productive and well-managed billing relationship by companies that promise–but fail to deliver–lower rates and higher returns. Such was the case with this client. Smitten by a competitor’s promise to save 40% on billing, they jumped ship and went with the other company. “If we can save that much and get the same result, why wouldn’t we?,” they reasoned. The problem for them was that the result wasn’t the same.
Not by a longshot.

Despite retaining the same providers, patient volumes, payer contracts, and documentation system, the ‘immediate’ savings the practice was promised never materialized. Even worse, after three full years, reimbursements were still far short of what Brault had consistently produced. When their patience ran out, practice leaders ran back to Brault.

Intelligent Practice Solutions

To help the independent emergency physician group address its business challenge, Brault provided the assistance below from its full suite of Intelligent Practice Solutions.

Patient Account Tracking. Like others before it, this practice implemented Brault’s proprietary Patient Account Tracker (PAT) system. Because PAT allows users to view and search patient encounters, check chart status, analyze documentation deficiencies, and access up to 13 months of historical data, it is the ideal tool for educating groups or individual practitioners about their charting performance. Increasing physicians’ personal behavioral awareness can lead to higher revenues and better compliance with Medicare and other payer guidelines.

Nurse-led Coding. Support for the transition back to Brault included reimbursement coding by our
U.S.-based nurse coders. Their advanced medical training and firsthand clinical experience allowed them to more accurately capture every appropriate charge.

Additional Revenue Generation

Practice Management (Personalized Physician Education). The group continues to leverage Brault’s personalized education platform. Providers simply choose an area of interest and select a convenient time for their online review, while Practice Improvement Specialists search for relevant examples from their own work to review along with them.

“They’ve done a great job working one-to-one teaching our providers the subtleties and best practices of ED documentation… We don’t see Brault as our billing services vendor but rather as our practice advocacy and advisory partners.”
— Practice leader

Outcome and Results

After successfully reestablishing the group’s coding and billing processes, and restoring income to previous levels, we began to explore other revenue generating opportunities. One of our studies revealed that up to 10% of the client’s patients qualified for observation management, including some that could avoid a hospital admission. This, of course, made them very happy. Because when implemented properly, observation medicine is a financial win-win for the doctors and their hospital.

So we created a new business model, which the group presented to hospital execs, showing all the benefits the hospital could reap from having an observation care unit, including significant improvements in revenue, operations and patient satisfaction scores.


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