The other variable is staff time, not necessarily reflected in your calculations above. Randomdoc1 how much time are you or staff spending on billing tasks, benefits look up, mailings of bills, digging into denials, resubmits, or simply chart review to see what needs a little work? What's the hourly time/wages spent on that?
My pre-calculations so far reflect whether I do it in house in fashion you are describing with Luminello and my assistant, versus using a billing company and my assistant, pencils out to possibly be the same, at least for a snap shot of this years projections. Optimistically it might be less this year if I make the switch to full Luminello. Did you have an inflection point where it clearly is more cost saving to have it done internally?
Wow, that's a great question! Admittedly, I have not crunched numbers prior to executing this as tightly as you are in the process of. I sort of looked at it at a much more approximated manner, how many hours am I working a week and what am I bringing home versus what other employers offer me. I work about 35 hours a week and have a nice income. Some of those hours are administrative duties. With help of the aging report, I suspect each week the time for billing tasks looks like the following:
Following up old claims ~1 hour
Following up unpaid balances of patients ~2 hours
Checking benefits and eligibility each week ~3 hours
-Icanotes has a nice export feature. Pulls up the patients for next week on an excel file with insurance plan, ID number, patient DOB. Then I sort the sheet by payor and go through all the sites and check 1)insurance still active and 2)what is patient responsibility. Doing this in bulk and by payor saves a LOT of time
Sending out bills ~2 hours
Denials and resubmits ~1hr A MONTH
I think 8 months in is when I could reliably see the pay off. Probably even before that. Anyways, definitely by the profit and loss report on quikbooks after my first year in, that's when I saw the over 420k profit I brought home and then you know it was the right move. Seeing patients 3.5 days a week and half day a week doing admin work.
I've hired staff at ~$17-18 an hour. No benefits. Some day when I'm big enough, I will try to offer that. I train my staff to:
-do basic front desk phone work
-work on insurance aging and patient aging reports. It is broken in an alpha split. E.g. someone gets the first half of the alphabet by last name and other person gets the rest. That way they are incentivized to get the claims/balances paid or else their work will just keep piling up.
-I'm the one sending out the bills and checking benefits and eligibility.
I think a big trick is finding someone who is smart enough who can start to assume all these responsibilities so I won't have to do any of it eventually. But as an owner, it is good to know all of it, you will see where the money is made and lost. A smart, highly qualified, and motivated person has been hard to find so far. There's a lot of number crunching and there's a learning curve to understanding the insurance language AND persuading patients that yes, you need to pay for your care.
Another thing I learned, make sure you hire people that produce well for the clinic. It's in their best interest too. I've had employees who would drag their feet in scheduling new patients. I even caught some discouraging callers from scheduling, especially if the employee thinks you don't know. They just become dead weight that 1)costs you way more than the hourly wage you pay them and 2)poison the culture of the company because other people start to follow suit. I've worked hard to foster a culture of, let's all try to succeed together and when there is work to be done, let's be go getters and not "it's not my job". My new phone system, although I did not get it for this reason, allows me to see a call log. Incoming and outgoing. How long did the call last, missed calls, calls that went to voicemail, which number was called, which number did the call come from, etc. It was telling. I have found employees who when I'm not out there, purposely did not answer calls. I've learned that you try your best to promote growth in your employees but some don't care to change. Fire them. Try to make it an amicable break up but they have no business poisoning a practice you worked so hard for.
Also, harass those insurance companies. Keep negotiating fee schedule increases. They will do it! I got a 30% fee schedule increase with United. Cigna and some marketplace plans I was successful with too. Increasing revenue per unit of time is a super smart move and will allow you to really let that practice boom. And get this, some payors I persuaded them to pay me $207 for 99213+90833. Yea baby!!!