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Practice Management

The Shrinking Private Practice: Why Billing Expertise Can Be a Lifeline

As a professional in the field of medical billing and revenue cycle management (RCM), I've witnessed firsthand the mounting pressure on independent physicians. But recent data from the American Medical Association (AMA) underscores a trend that many in the healthcare world have felt coming for years: The decline of private practice is accelerating.

Staggering statistic: Only 42.2% of physicians now work in private practice, down from 60.1% in 2012 (Fierce Healthcare).

Taking Advantage of a Downward Trend

The good news? The private practices still in operation are realizing more than ever that every penny counts and they are turning more to billing companies to do the dirty work of billing and denial management.

Why Billing Companies Matter More Than Ever

While many practices look to mergers or private equity for relief, others still fight to remain independent. These physicians—resilient, resourceful, and committed to autonomy—need more than just encouragement. They need strategic partners. That's where professional billing and RCM firms come in.

Physicians cite poor payor reimbursement (71%), limited contract negotiation leverage (64%), and administrative complexity (63%) as the leading reasons for leaving private practice (AMA).

Each of these pain points is directly addressed by a strong billing partner:

Maximizing Reimbursement: Proper coding, denial management, and payor negotiations.
Reducing Administrative Burden: Taking over prior authorizations, documentation, and compliance.
Operational Stability: Offering consistent cash flow and reliability where staffing is limited.

The above can be achieved in a number of ways: adopting newer technologies such as cloud-based billing/PM/EHR with built-in AI tools, reducing staff, adjusting staff roles, and utilizing outside billing firms.

Billing companies can be the difference between burnout and breakthrough.

A New Kind of Marketing Message

As you are probably the sole marketing person for your billing business, when it's time to talk with doctors or office managers, spewing product features and talking about price is going to ring hollow in today's environment.

Doctors want to know that you have a track record, and can be a trusted partner, not another salesperson. Be reachable. Giving out your cell phone number so they can reach you at any time speaks volumes. It helps if you are local too—"neighbors" if you will. They hate feeling like just another "support ticket."

Here are a few key marketing strategies that resonate deeply in today's environment:

Educate to Build Trust: Utilize stats from trusted industry sites like AMA to inform and be informed. Host webinars or create guides on reimbursement optimization.
Pro tip: You can hire experts on LinkedIn to present or write for you.
Become the Expert: Position yourself with a professional website, marketing materials, business cards, etc.
Pro tip: Apps like Canva can get you far, but sometimes you need to let a pro do it. Try Fiverr, for example.
Stand Out From the Crowd: Utilize best-in-class software systems and offer a suite of solutions and services, not just billing.
Pro tip: Credentialing, coding audits, and patient engagement tools are in big demand at the moment. You can partner with another company to offer these.
Harness the Power of Referrals: Polish up your networking skills, using in-person events and online sites, such as Alignable, to connect.
Nurture Your Contacts: Leads are easy; the follow-up is what's most important. Use a process of information gathering, provide data to support the effectiveness of outsourced billing, and then be sure to add your contacts to a CRM or automatic drip email system to stay in touch. When the doctor is ready to make a decision, you will be top-of-mind. A "no" now doesn't mean it won't turn into a "yes" later if you nurture properly!

Final Thoughts

The decline in private practice is not inevitable; it's a reflection of a healthcare system that often punishes independence. The private practice is not going away. In fact, I am seeing trends in the opposite direction. There have been recently formed physician groups that aim to check private equity's expansion in U.S. medicine.

Revenue cycle management is no longer just another back-office task; it is mission-critical.

Adam Phillips is CEO of American Business Systems, a leader in healthcare revenue management solutions.

American Business Systems – Medical Billing Business Opportunity

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The CERT Program: What It Is and What a Practice Needs to Know:The Comprehensive Error Rate Testing (CERT) program is a crucial component of the Medicare program that helps ensure the government is paying only for the services and care that beneficiaries actually receive. The program is designed to identify improper payments made to healthcare providers and suppliers under Medicare Part A and B and Durable Medical equipment MACs (DMACs). This article will explore what the CERT program is, how it works, what a practice should do if a CERT request for records arrives, and how the CERT report can be used to help a practice stay compliant.

Practice Management
Harness the Power of Patient Reviews to Elevate Your Practice:When was the last time you made a purchase without looking at product and service reviews? Amazon, Facebook, Google, Netflix, Uber, Travelocity - powerhouse, world-changing organizations all built upon the culture and value of reviews. Healthcare is not immune to the review culture; with our consumerized patient, positive public sentiment is liquid gold and one of your most valuable assets! In fact, 86% of top performing healthcare providers are asking for reviews and feedback after every patient encounter.

Practice Management
Transforming Rural Healthcare Delivery: The Mission and Vision of the Office of Rural Health:For many rural communities, accessing quality healthcare remains a challenge. Geographic isolation, insufficient medical facilities, and a lack of specialized care providers can create significant barriers to adequate care. Recognizing these issues, the Office of Rural Health was established with the goal of improving healthcare in rural areas. This article will explore the mission and vision of the Office of Rural Health and discuss how its initiatives are transforming rural healthcare delivery.

Practice Management
Part 1: Basics of Artificial Intelligence (AI) and Healthcare Compliance:Artificial intelligence (AI) technology has created new opportunities to progress on critical issues, such as health, education, and the environment. In some cases, AI may do things more efficiently or methodically than humans.

Practice Management
Freestanding Emergency Center (FEC) Industry Lobbying Goes to Washington:In early February, members of the National Association of Freestanding Emergency Centers (NAFEC) went to Washington D.C. to meet with various members of Congress to gain support for two items: the continued recognition of Freestanding Emergency Centers post pandemic and for oversight of the No Surprises Act Independent Dispute Resolution process.

Practice Management
The Significance of Not Obtaining Patient/Consumer Consent Before Poaching Data:Now, in 2023, the FTC announced two consent orders related to the prohibited poaching and use of PHI by known third parties and the DOJ announced another settlement under its Civil Cyber-Fraud Initiative.

Practice Management
Seven Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth Fraud:n September of 2022, the Office of Inspector General (OIG) released a report, "Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks," in which they identified that approximately two in five Medicare beneficiaries used telehealth services within the first year of the pandemic to receive healthcare services from a Medicare provider. This is approximately 88 times more often than beneficiaries engaged through telehealth services prior to the pandemic.

Practice Management
The Crucial Role of Negotiating Payer Contracts Every 18 Months for Physician Offices:The healthcare landscape is constantly evolving, with changes in technology, patient care, and the business of medicine all occurring at a rapid pace. One area that is often overlooked but is equally critical to the success and sustainability of a medical practice is the negotiation of payer contracts.

Practice Management
Revenue Cycle Challenges: The Financial Savior:As consumers, we all face challenging inflationary pressures in our lives, with everything presenting challenges to our budgets. Essential groceries and other items are up significantly, posing tremendous financial obstacles for all consumers. The Consumer Price Index (CPI), a closely watched gauge of inflation, recently showed that price increases continue to slow.

Practice Management
Is the Violation Right of Access or Information Blocking? Do You Know the Difference?:The right of access and information blocking are both related to the access and exchange of health information, but they are different in several key ways. HIPAA Privacy/Security and Compliance Officers and Health Information Management professionals need to know the difference. It is important to differentiate between Right of Access and Information Blocking to ensure your organization is compliant with both rules, as well as any applicable state privacy regulations.

Practice Management
Healthcare Compliance: A Unique Opportunity to Impact the Business Side of Medicine:I have been privileged to make my entrance into the world of healthcare, in medical coding, specifically after my first career as an art historian dissolved way back in 2008 due to the recession. Mind you, I have taken all my research skills, writing, communication, and critical thinking strengths along for the ride.

Practice Management
Overcoming Self-Pay Challenges in Revenue Cycle Management:Amid the headlines of labor shortages and hospital closures, many Americans may have missed some positive recent healthcare-industry news: The U.S. reached a new, all-time low in the rate of Americans without health insurance.

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BYOD and Related Important Training and Policy Considerations: The Growing Compliance and Litigation Risk and What to Do About It

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Practice Management
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Appreciating the Anti-Kickback Statute's 1/3 Income Rule for ASC Investments and a Recent Case Involving Not Meeting the Personal Service & Management Contracts Safe Harbor

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