The numbers jump out at you. Steven Peltz, CHBC, a leading practice management consultant, estimates that over 40 percent of an average practice’s accounts receivable are over 90 days old. As Peltz points out, this may signify a lack of a sound process for collecting on overdue accounts or perhaps less effort in collecting on older claims and denials as they may be more difficult and time-consuming than collecting on more recent claims.

     This is one of the salient points that emerges from Peltz’s cover story, “In-House Billing: Assessing The Pros And Cons” (see page 40). Deciding whether to delegate billing tasks to your staff, outsource these tasks to a outside billing company or have some combination thereof appears to be a fairly complex decision.

     One might assume that you have a little more control and can oversee things if you have a staffer manage these tasks in-house. There may also be a little more accountability with this approach. However, there are also potential drawbacks.
As Peltz points out, if you have a small practice or are just starting out, your billing person may double as both a medical assistant and the billing coordinator. There is another question that one should consider as well. What happens when this valuable staffer is sick, out on vacation or leaves for a position at another practice? Do you have a backup plan? Is there another staffer who can step in his or her shoes?

     On the other hand, billing companies may be able to provide more expertise and backup options, and possibly facilitate less training costs. However, this may involve sacrificing some control and as Peltz notes, some billing companies may not dedicate too much time to answering the questions of a small practice.

     While some busy practitioners may fall prey to assumptions about their billing operations, I doubt there are too many pat assumptions about compliance among patients with diabetes. Many folks have emphasized the importance of glycemic control to facilitate lower-extremity wound healing in this patient population. Accordingly, Jennifer Pahira and John Steinberg, DPM, offer a closer look at the development of inhaled insulin in “Is Inhaled Insulin A Viable Alternative For Patients With Diabetes?” (see page 20).

     Then there is the age-old issue of compliance with therapeutic footwear among patients with diabetes. In their article, “Tissue Volumizing: Can We Create An Internal Orthotic?” (see page 58), Stephanie C.S. Wu, DPM, MS, Nicholas J. Bevilacqua, DPM, Lee C. Rogers, DPM, and David G. Armstrong, DPM, PhD, discuss the intriguing possibility of injecting tissue volumizing agents beneath plantar prominences in high-risk patients to create “an internal accommodative orthotic effect.”

     Speaking of orthotics, Douglas Richie, Jr., DPM, examines emerging research that reveals the benefits of orthotics in treating chronic ankle instability (see page 48). He notes that one of the surprising findings from the research is that reducing pronation of the foot is more successful than preventing supination or inversion when it comes to improving ankle instability.

     Rounding out this month’s issue, William Fishco, DPM, implores readers to redefine their perceptions when it comes to the surgical candidacy of geriatric patients (see “A Guide To Foot Surgery For The Geriatric Patient” on page 76). While there are key considerations and precautions to keep in mind, Dr. Fishco notes that, in general, “patients well into their 80s tolerate foot surgery very well.”

     Whether it is rethinking an approach to billing or exploring new alternatives in patient care, these authors make it clear that we shouldn’t be afraid of emerging ideas that may challenge longstanding assumptions.