3 Medical Franchise Billing Mistakes You Don’t Want to Make

By: Justin Irizarry

Running a medical franchise involves a lot of moving parts. From staffing your location with the most talented employees to ensuring patients are experiencing stellar healthcare and customer service, some housekeeping things like billing can get triaged to a secondary position. However, there are a few billing mistakes that you absolutely want to avoid when it comes to your medical franchise.

1. Ignoring Your Billing. The top mistake that medical franchises make is ignoring their billing! It might seem like something that shouldn’t fall through the cracks but there are a few specifics to medical billing that the average entrepreneur won’t be an expert in. As a result, hiring staff or outsourcing billing to a professional service is key in making sure your billing is accurate and up to date. There are seven Cs of billing that those responsible for your billing must be experts in:

• Contract negotiations
• Credentialing
• Coding
• Compliance
• Claim submission
• Claim formatting
• Collections

Hiring a medical franchise biller who knows each of the above-mentioned items through and through is key to the success of your business. Finding qualified employees for a billing position can be difficult due to high demand, but finding the right fit can make the difference between your success and failure. As an alternative to hiring an employee, outsourcing your billing to an expert service is also an option.

1. Untrained Biller. This leads us to the next point: Do not put your billing in the hands of an inexperienced employee. While it might seem appealing to save a little money on hiring an inexperienced billing person, in the long run it will hurt you. As a new medical franchise, your business needs to have someone who has a wealth of experience handling billing (and by extension revenue) for your specific industry. Medical billing is complex and trying to do it yourself or hiring someone who hasn’t been trained in the industry can result in a loss of a substantial income.
2. Using the Wrong Type of Billing Company. Outsourcing your billing to a qualified company is an excellent alternative to hiring a professional in-house. However, not just any billing company will work for your specific medical franchise. Using an emergency department or primary care billing company can be a huge mistake for your new business. Selecting a company with integral knowledge to how your medical franchise’s billing works is key in the success of your business. Choosing the right company to handle your billing might be the most important decision you’ll make. Ask questions! What’s the company’s background? Do they have success in being diligent and aggressive in getting payments from difficult sources and past due accounts? And, of course, always check to make sure that their service fees are in line with what you’ve budgeted.

OrthoNOW is the first and only Orthopedic franchise. Contact Christine Dura at Christine@orthonowcare.comfor more information about franchise opportunities.

Make sure to thoroughly vet anyone you’re going to trust with your billing. Though it’s just a part of your overall medical franchise business, it’s one of the most important. Ensuring your revenue is as projected, as much as you have control over, will make operating your location that much more effective.

Justin holds a B.A. in Economics from Cornell University, where he was a 4-year varsity baseball scholar-athlete, and a M.B.A. from The Wharton School at The University of Pennsylvania, where he was a Joseph Wharton Fellow. In addition, he has earned the right to use the Chartered Financial Analyst® (CFA) designation, the most respected and recognized investment designation in the world. Justin has more than 13 years of experience acting as a trusted advisor and interim executive for a wide range of companies. His diverse business experience has led him to advise for boards of directors and senior management teams in the education, information, digital real estate, medical, and technology industries. Justin started his career on Wall Street with the Education and Information Group at Scott-Macon, Ltd. As the Vice President of Scott-Macon, he was responsible for sourcing and executing transactions in the $50 – $300 million range. Justin joined OrthoNOW® in 2010 and started the Franchise with Dr. Alejandro Badia in 2012. In addition to his role as Co-Founder &CFO, he serves as the Director of Operations of OrthoNOW® Doral.   

Justin remains active with his alma mater and serves as a volunteer mentor to incoming freshman as part of the university’s Alumni-Student mentoring program and as a university interviewer for South Florida applicants to the university.  Justin was recently named a Top 40 Under 40 by South Florida Business Journal for his contributions to the South Florida community as the CFO and Co-Founder of OrthoNOW®, the nation’s only network of orthopedic urgent care centers, and for his work in developing and activating a business model that changes how South Floridians access expert orthopedic care on-demand and at a cost-effective rate.