Four decades of billing, collections: How times have changed

When Dr. Painter started practice during the early 1970s in a small town in western Colorado, the entire billing and collections process was much simpler. When a patient had no insurance and told you they had a problem paying your bill, you knew they had a problem. In western Colorado, close to one-third of the patients had no insurance and very little money. Payment plans would be worked out with some patients and with others, the chickens were good, the eggs were excellent, and you can’t beat western Colorado lamb. Almost everyone paid something or tried to pay in some way for their services.

When Blue Cross was billed for a service, the bill was paid, usually at the insurer’s contracted rate and with no questions asked. (Even then, it paid to review the explanation of benefits.) The number of plans was limited. Medicare paid based on previous charges using far less complicated rules and regulations. In short, billing was simple and required very little training or knowledge. Ah, the good ol’ days.

When we founded Physician Reimbursement Systems in 1989, those days had gone the way of walking to work uphill both ways and barefoot. We had a new set of problems to solve. Since 1989, the system has been increasing in complexity and in administrative distractions. Patients are more numerous and many are less connected. Almost all patients are more confused by what coverage they have or don’t have, and many still believe that insurance covers everything. There are an increasing number of patients who have become experts at beating the system and not paying their doctor bills. Unfortunately, not all patients can be trusted.

There are multiple insurance companies, many different coverage packages for different policies, in-network and out-of-network issues, different payment rules for each payer, lower adjusted payments, and higher practice costs. And this list is not even inclusive of all the changes that are applying stress and pressure on top of the real calling to practice medicine. It is easy to see why physician dissatisfaction is at an all-time high.

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