Peering into the Black Box: Billing and Insurance Activities in a Medical Group

Health Affairs Web Exclusive
Vol. 28, No. 4
May 14, 2009
Sakowski, J.A., Kahn, J.G., Kronick, R.G., Newman, J.M., and H.S. Luft
pp. 544-54

Billing and insurance–related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians’ time, was at least $85,276 per FTE physician (10 percent of revenue).

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