What to look for when evaluating a medical billing provider for your practice

If you have practiced medicine for some time, you probably agree that the healthcare industry has become incredibly complex in recent years. Thanks to ever-evolving regulations and changing reimbursement models, physicians are forced to optimize their operational processes in an effort to reduce expenses and increase revenue.

One of the best ways that practices can increase your revenue and stay competitive in a sometimes volatile market is to outsource your billing to a third-party vendor. But how do doctors ensure they select the right partner?

First by asking yourself a series of questions and then by asking your potential partners another series of questions.

Questions to ask yourself

What are my particular pain points?

Any billing company worth its salt will have policies and procedures that will maximize the efficiency of your practice workflow and minimize the time it takes to collect. And, at this time, all quality providers will have rigorous compliance programs in place to ensure the security, privacy, and confidentiality of protected patient data.

But beyond these generalities that any doctor requires, what are the particular challenges or problems that you face on a daily basis? What are your personal pain points? What are your preferences: cloud-based or enterprise-wide solutions?

Once you have a list of your preferences and challenges, you can more easily communicate them to potential partners.

What stipulations do I require in the contract?

A partnership is a two-way street and an effective contract will clearly describe the provider’s scope of work as well as their responsibilities (i.e. provide all necessary documentation and authorization for services). Since using a generic contract template creates problems, get legal advice and determine your requirements: effective dates, termination clauses, compliance requirements, service reimbursement parameters, and scope of work.

In what ways can my billing partner help me grow my practice?

Not only should the right billing partner be able to handle your payments and claims, they should also be able to advise you and assess the health of your practice. Ask yourself what kind of assistance you need to determine if your current IT management policies, staffing levels, and resources are sustainable. How can your billing partner help you prepare to meet future goals?

Questions for prospective partners

What technological capabilities do they offer?

Good billing companies offer more than help with claims and reimbursements, they have extensive knowledge when it comes to the best technology available to meet your needs and regulatory requirements.

Ask vendors about their experience with EHRs, practice management systems, and if their solution can be integrated into their existing systems. Remember, technology is multifaceted and should help you meet the clinical, administrative AND financial needs of your practice.

Is the ICD-10 billing company ready?

At this point in the game, all billing companies should be up to date with the ICD-10, there is simply no excuse not to be prepared. Ask potential partners if they have completed end-to-end testing and have completed the proper training for their coders. Are you ready, willing and able to handle any refund issues due to denied claims?

Do any of your other clients share your specialty?

Let’s face it, coding and billing are complicated and there are different sets of rules depending on the specialty. Does your potential partner have experience in billing your specialty? If not, find one that does and can customize your solutions.

Whose software will you use?

Will you continue to use your own practice management software (PMS) or does your provider have yours? Most EMR software has built-in practice management components. If the provider is going to work on your current system, ask who will cover the cost of the clearing house and if you will have to pay any fees. If you are going to use the vendor’s PMS, be sure to establish guidelines in the contract stating that you have rights to their billing data and reports.

Will they carry out regular audits?

One of the biggest threats to a practice’s cash flow is complacency. For this reason, it is important that your provider conduct regular claims audits to detect any under or over coding. Ask them how often they do it (it should be quarterly) and how many charts they cover (it should not be less than 10).

How many certified coders do you have on staff?

Ask how many certified coders they currently have on staff and how many will be dedicated to your account. It is your right and responsibility to know exactly who will work with your claims and what level of training they have received.

How often will you file your claims?

It stands to reason that the frequency of claims submitted will determine your income stream. Claims can be submitted daily, weekly, or biweekly. Be sure to establish guidelines on how claims should be submitted to maintain cash flow.

How do you handle rejection?

While most humans handle rejection of any kind fairly poorly, it is your billing provider’s responsibility to be excellent at handling rejections – claim rejections. Your provider must be able to identify triggers and denial patterns and fix issues immediately to increase revenue.

Who handles patient questions and concerns?

Not all providers take their patients’ calls when they have questions about their deductibles and copayments, so know in advance what your preference is. If you don’t want these calls going to your office, ask beforehand if this is something they handle.

What types of reports do you provide?

Without question, you should receive monthly financial reports from your provider that include payments, adjustments, billable services, and accounts receivable. Also, find out if they can provide you with customizable reports, which can give you specific data on denied claims and procedure codes.

Knowing your exact needs and then evaluating potential partners by asking these questions will help you find the medical billing provider that will help you maintain a financially successful practice.

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