It is a question often pondered by practice managers and others overseeing the financial aspects of an imaging enterprise: What guidelines or benchmarks do I use to determine whether to retain my in-house billing department or outsource billing? At a June 9 session at the RBMA conference in Orlando, Florida, Randal Roat, vice president of radiology services for MMP (Flint, Michigan), and Michael Gonzales, billing operations manager for Radiological Associates (Sacramento, California), provided a unique, engaging, and informative approach to answering that very question.
The high level of audience participation was due to the session’s novel format: Roat assumed the role of the billing department manager for an imaginary practice called Everywhere Radiology Group (ERG). Gonzales played the part of an executive with an outside billing company.
Over the next 30 minutes, the speakers presented a series of slides detailing the financial state of ERG’s billing department, as well as the RBMA benchmarks for those categories. This side-by-side comparison was, perhaps, the most important information offered during the session because it provided attendees with an idea of how their performance compares with the RBMA survey results. To allow for the fact that many of those in the audience may not have been familiar with the accounting or billing terms presented, the audience was provided with brief descriptions:
- adjusted collection percentage indicates how well a billing office is collecting what is expected to be collected,
- days charges in accounts receivable provides a rough measure of how long it takes to collect,
- bad-debt recovery is the percentage of collection-agency write-offs recovered, and
- cost of billing includes all costs incurred in the billing/collection process.
Key points of comparison between ERG’s financial indicators and RBMA benchmarks are shown in the table
|Table. Performance of a hypothetical company (ERG), as compared with RBMA benchmarks.|
|RBMA Key Indicator||ERG||RBMA|
|Adjusted collection percentage||76%||84%|
|Days charges in accounts receivable||65||47|
|Total adjustments (as % of gross charges)||15%||57%|
|Total write-offs (as % of gross charges)||20%||7%|
|Total write-offs (as % of adjusted charges)||24%||17%|
|Aging > 120 days||22%||16%|
|Collection-agency write-offs (as % of gross charges)||18%||7%|
|Collection-agency write-offs (as % of adjusted charges)||22%||17%|
|Bad-debt recoveries (as % of collection-agency write-offs)||6%||8%|
|Billing/collection expense percentage||12%||9.3%|
|Billing cost per procedure||$3.50||$3.37|
From the outset, it was made clear that there are many variables in any practice that can influence the decision beyond a comparison of figures and percentages, including the percentage of Medicaid patients, geography (inner city versus suburb), and competitive issues.
Gonzales, who has 13 years of prior experience with a medical billing company specializing in anesthesia, says, “We took a case study out of an RBMA accounts-receivable survey. Then, we took some of the variables that are in an urban, hospital-based practice with a high indigent population, high Medicaid, and possibly no CT. All those factors are relevant.” ERG is also described as having no MRI because another facility was first to get the required certificate of need.
When all is said and done, however, the true cost of in-house billing versus the percentage paid to outsource the function is often the tipping point for the decision. “We wanted the audience to look at the numbers not as a static comparison, but including the environmental factors that make each practice unique. A lot of it depends on the payor mix,” Gonzales says.
After reviewing the benchmarks and comparing ERG and RBMA data, it is time for the audience members, playing the roles of radiologists, to ask questions. One asks how the provider would get its data back if its relationship with the outsourced-billing company fails. “We will create a file to transfer