Medical Billing and Trust
“This is a $29 billion dollar industry that is built on trust”. Michael N. Brown, CEO of Fellow Health Partners is speaking about medical billing, the backbone of America’s $3 trillion medical system. “Most people don’t realize how important medical billing is.”, he says. “It’s the way doctors, hospitals, and practitioners get paid. It’s the lifeline between insurance companies, patients, and the medical providers. Without it, the whole ecosystem simply couldn’t function.”
Yet, the medical billing system is far from perfect. Although it functions, there are lots of errors, miscommunications, constantly changing payment rules and a series of rising costs that affect patients and providers alike. It was because of his desire to understand and smooth out these imperfections that Michael was attracted to medical billing.
Gaps in the Medical Billing System
He says, “It all started when the founder of a small medical billing company asked me for business advice. To get a better understanding of their world, I started to ask questions about medical billing, and the more I heard, the more surprised I was. For example, I learned that a doctor could do exactly the same procedure five times and be paid a different amount for each of the first four procedures, and then be paid nothing at all for the fifth. All these different amounts didn’t make sense to me. Then I learned that when billing is done incorrectly, both the doctors and the patients paid the price. I asked myself how could someone trust a system like that? The more I learned, the more I started solving for what I felt was an unfair system and how to fix it.”
After extensive research, Michael and his team learned that there was a gap in billing company options, which he called “an unmet need”. It appeared that medical providers often had only two options when it came to billing, neither of them entirely satisfying.
One was the service-focused, local “mom and pop” billers who were available for a phone call or even a personal visit with doctors and practitioners, but who often lacked resources to grow effectively when their clients grew. They couldn’t scale. They couldn’t keep up to date with changing rules and regulations and didn’t have access to the most up-to-date technology. Although their clients trusted them, they weren’t collecting every dollar they had billed for their clients.
The research showed that the other option was the large, impersonal “offshore” assembly-line type billing companies that prioritized ‘throughput’ above all else. They simply submitted bills, often didn’t follow up on claims, and were more concerned with volume, which meant that they weren’t collecting every dollar they had billed for their client, either.
Both options had simply grown reactively over time. Neither option had been designed from the start to solve for current industry problems, which unintentionally made things worse.
To Michael, this suggested there might be a business opportunity to improve both customer service and revenue for doctors, practices, surgery centers, and hospitals.
He started with the observation that trying to “fix” the problems wasn’t the answer. Too many things were already broken. The “mom and pop” billers had never set out to build scalable, technology assisted services. The large, impersonal “offshore” companies were built to provide unrealistically low rates, not to collect every dollar, which meant a lot went uncollected.
Fellow Health Partners was created to meet the new, evolving service and revenue needs by providing a combination of “high touch”, responsive service on all levels as well as “high tech” billing and workflow processes, to guarantee accuracy and quality.
Michael explains, “My prior training and business experience had focused on strategic vision, organization, and efficiency. That’s why before we launched Fellow Health Partners, we spent over a year building the infrastructure of the company. We mapped out all the training, we built the tech to serve our clients, and we committed to a highly supportive work environment so we could attract and keep great talent. Then we formally launched. This preparation has allowed us to scale rapidly year after year, while providing highly customized service. Because of this solid foundation, quality is high, and our clients say they really trust us to get things done right.”
Building and Maintaining Trust
“We reinforce their trust by focusing on security, revenue integrity, and compliance. We follow a diverse set of National and Local rules while regularly updating compliance training among our staff as well as our clients. We also maintain our own in-house tech team to make sure that our systems integrate smoothly and safely with our clients.”
Fellow Health Partners’ robust IT development and support team is under the direction of Ali Raza, Senior Systems Architect. When asked about the relationship between tech and trust, he says, “The trust comes from so many things. For example, our custom built SAVi™ software allows doctors, practices, and facilities to have access to their accounts 24/7. It is completely transparent. Nothing is hidden. They can see what they want right away, in real time, instead of waiting days or even weeks.”
He adds, “SAVi™ automatically generates customized reports that are tailored to meet the individual needs of each client. These reports provide the managers, physicians, and administrators with the information and analysis they need to improve their operations, to become more efficient and make more money. Customization makes our clients more comfortable with us and, since trust is simply the end result of comfort over time, this comfort with customization leads to more trust.”
Trust is such an important part of the relationship between a medical billing company and its providers that it is included as a core part of the curriculum at the Knowledge College™, the in-house training facility at Fellow Health Partners.
Michael Brown says, “As Ali mentioned, trust is easy to measure because it is the result of a client’s comfort with you over time. If they are uncomfortable, trust starts to weaken. If they are comfortable, it gets stronger. That’s why we strive to keep comfort high. We’ve learned that competence builds comfort, so we focus on training and KPIs (key performance indicators) generated by SAVi™. This allows us to constantly improve our processes, which results in increased competence and even better outcomes for our clients. Our goal is to turn this service into higher levels of trust.”
Business and Reputation
The medical biller who first came to Michael asking for advice about her company, was Alexandra Stephens. Today, she is a Divisional Director of Fellow Health Partners, managing a growing team of certified billers and coders. When asked what has made Fellow Health Partners become such a successful and trusted company, she doesn’t hesitate. “Our clients have said that they feel comfortable with us, that they feel valued and served because we work to get the most money for their services as quickly as possible. We work denials diligently, which many billing companies just don’t do. We ensure that all coding is compliant and optimized, while ensuring that A/R is kept to a minimum. And we provide it at a fair and effective rate.”
She adds, “I think our clients trust us for four reasons. First, our people – we hire the best, train constantly, support them, and encourage them to grow. Second, we collaborate closely with clients – before we even start the onboarding process. Third, our technology – everything from EHR solutions to our SAVi™ system is designed to make things easier and more accurate. Fourth, our training – our Knowledge College™, which is one-of-a-kind. Our people gain enhanced technical and people skills, which helps when dealing with insurance company personnel and patients.”
Michael Brown looks ahead and sees a great future. He says, “We are expanding our service offerings, putting a special focus on Advisory Services to help our clients manage and grow their businesses. We are working hard to make things easier for patients so they can trust that we did everything we could to get paid by their insurance provider. We are focused on new ways to seamlessly and compassionately collect the portion they are responsible for, which continues to grow as health care costs explode.”
“We are partnering with larger and more complex clients who share our view of what’s necessary for success in the medical industry. Because the Fellow Health Partners’ platform continues to allow for exponential growth, the M&A opportunities continue to play a large role in our expansion, and we expect to collect over half a billion dollars annually for our clients within the next 2 years.”
“The reason we can do all this is because we have developed so much trust with clients, employees, and the industry that we can comfortably springboard from those relationships into the future. For that, we are very grateful.”
*** The interview originally appeared in The Silicon Review. Read it here.