I spent the last few days of September with the owners of medical billing companies in Las Vegas.
The trip was not intended for fun, but to learn more about the state of the third-party medical billing industry in 2009.
The Healthcare Billing & Management Association, or HBMA, held their 2009 Annual Conference at an auspicious time. As HBMA members met in Vegas to discuss their concerns, the healthcare reform debate in Congress was gathering steam, and HBMA members wondered how the reforms would affect physician reimbursement and compliance issues, and hence, their livelihood.
Third party medical billers process medical claims for physicians and other healthcare providers, and often perform administrative functions for medical practices, including accounts receivable management, medical billing consulting, and other practice management services.
According to Randy Roat, HBMA’s immediate past president, third party medical billing companies process approximately 17 million claims per month, or more than $18 billion per year. A “typical” HBMA member processes approximately 20,000 claims per month, or about $20 million per year.
Most of these companies are not publicly-traded behemoths, but small, regional – often local – operations.
Unlike many of the industry players in the healthcare reform trenches, the medical billers don’t appear to be weighing-in heavily on one side or the other. Indeed, Roat says that third-party billers are one of the few groups without a “direct financial motive” driving them to lobby for or against reform.
“Our space is primarily regulatory,” Roat told me. “Our message is one of administrative simplification.”
My conversations with billing company leaders seemed to confirm Roat’s assessment. Many billing companies do have antagonistic relationships with commercial payers, so it wasn’t surprising to hear some billers speak in support of an increased governmental role in health insurance. One man told me that Medicare was an excellent, efficient payer, and he wouldn’t mind seeing a more dominant role for the federal government.
Other billers feared that an increased government presence in healthcare reimbursement might ultimately put third-party billing companies out of business.
The biggest issues discussed by billers at the HBMA conference were, as Roat suggests, administrative and regulatory. Such topics don’t get much play in the popular press or on television, but they are essential to the business of healthcare.
You don’t see many videos of protesters yelling at congressional town hall meetings about the transition to ICD-10 or physician quality reporting initiatives. But issues like those are “where the rubber meets the road” in the healthcare finance universe.
Holly Louie, compliance officer at Practice Management, Inc., a Boise, Idaho-based billing company, speculated that ICD-10 implementation and the HITECH Act were the current hot topics for billing companies. Neither Louie nor anyone else I spoke with mentioned the spurious “death panels” or the “socialist threat” of the public option that occupied so much of the media’s attention this summer.
“There are many other very important topics, but ICD-10 and HITECH have the most immediate operational impact on HBMA members,” Louie told me. “They will demand the biggest changes in costs, training requirements and daily operations for billing companies.”
Congress will eventually produce some kind of healthcare reform legislation, but whether the resulting changes improve access to care, as well as quality of care, are uncertain.
But for the sake of the medical billers and other healthcare administrators, not to mention the providers they work with, let’s hope that reform legislation also boosts “administrative simplicity.”