Billing is one of the more time-consuming tasks for spine surgeons and their practices. While some groups outsource their billing, others prefer the control keeping it in-house provides.
Four spine surgeons discuss their strategies.
Note: Responses were lightly edited for clarity.
Question: What were your top priorities when deciding whether to manage billing in-house or outsource the work?
Ray Oshtory, MD. Pacific Heights Spine Center (San Francisco): Managing billing has been a constant struggle, unfortunately. Outsourcing to billing services is common with small practice and independent spine surgeons. My practice has also done this in the past with a few services. Every time, we have had the same issue: they are reluctant to follow up on denied codes as most spine surgeries have several codes, as opposed to a total joint surgery that just uses one code. For the services, it is much easier and less work for them to bill a single total joint code than it is to follow up on multiple denied spine codes, append modifiers, appeal, etc. So my practice has used in-house billers for the past several years. Unfortunately, it is quite difficult to find a qualified biller to work in house. We have been looking for an in-house biller for my practice (myself, a spine surgeon and my partner, a pain management physician) for the last six to eight months or so without being able to find anyone qualified despite multiple applicants. It is a difficult and tedious job, mostly because the hoops the insurance companies make us jump through, and the unethical games they play with denials. It is yet another industry ripe for disruption, either through proper regulation or perhaps AI, or both!
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: Our billing is in-house. With 30 plus surgeons and 70 providers we felt we needed tight control on billing and reimbursement. Outsourcing may only chase low hanging fruit, but in-house can chase most unpaid claims. It's about control.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): I would strongly recommend keeping billing in house. There will be a much greater degree of control over billing and collecting and more transparency. This in turn will result in less denials, better ability to manage denials, and greater collections. The physicians, however, will need to thoroughly understand the coding/billing/collecting process in order to effectively monitor (and adjust when necessary) their in-house billing process.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Priorities with billing originate with seasoned, experienced coding specialists who clearly understand the many variances and nuances of complex spinal care. This complements staffing familiar with appeals processes since the frequency route seems to have increased.