Choosing a vendor is never a simple task, but knowing what questions to ask makes it a lot easier. Here are three things to look for when selecting a medical billing service and the questions you should ask to determine if they fill the bill.
Don’t choose a Service based solely on price.
A full service medical billing company with experienced billers and advanced revenue cycle technology is able to command a premium for their services because their total collections are often noticeably higher. But if you happen to be overly cost conscious, don’t assume you’re getting a better deal from a discount or commoditized vendor because there’s a good chance you’ll end up realizing less revenue in the end.
For instance, some large well known national services advertise a rate of 2.9% of collected revenue with 94% first-pass claim acceptance levels, but that discounted rate comes at the cost of your insurance claim follow-up. And when there is no claim follow-up, that leaves 6% of your insurance claims unpaid –or roughly $1,400-$1,800 per month on average, left to pile up in A/R. Suddenly their ultra-low offer doesn’t look like so amazing of a deal.
You want your account handled by coders and billers who really know their stuff, making them highly productive and less prone to error, and you want a company that’s committed to collecting every dollar that you’ve earned.
– How many people will be assigned to my account?
– How many years’ experience billing do they have?
– How much experience do they have in my specialty?
– How do you ensure your billers are kept up to date on codes and regulations?
– What are your average days in AR for my specialty?
– What percentage of charges are turned over to a collection agency?
– What policies do you have that may affect my current processes?
– What is your process for protecting personal health information?
– What type of insurance coverage do you carry? (Errors and omission coverage? Liability for security breaches?)
–You want a company that is in methodical compliance with every federal and state law that applies to your practice.
Don’t underestimate the importance of technology.
Brown-Wilson’s 2014 Black Book Survey of 21,079 PM and EHR users on 455 different software, reports that 90% of physicians will now only consider an EHR centric software platform believing that seamless EHR/PM/RCM technology will ensure long-term practice productivity and profitability. In fact 82% of independent physicians surveyed said they intend to integrate practice management, billing services, and EHR software into a single vendor solution if possible by January 2016. This represents a monumental shift in perspective, since a very low percentage of practices today use an unified end-to-end PM/EHRsolution –and the population doing so tends to be heavily weighted towards large medical practices of over 25 doctors.
There’s an enormous difference between billers doing things the traditional way (manual data entry, faxes) and those using cloud-based revenue cycle management software. Think of it like your personal banking. Some people still collect piles of paper bills, write each payee a check, mail it, and manually tally their account, while others pay their bills online with the click of a mouse and no paperwork or postal delay.
With the right software, your office can be seamlessly be connected to the remote billing office, streamlining workflow and RCM processes for fewer errors—eligibility is checked before patients are seen; coders have direct access to patient data, insurance data, and clinical notes –eliminating data snags to correctly code each encounter; denials are received quickly and dealt with right away instead of sitting in someone’s to-do pile. Not to mention the fact that by using a cloud-based system, you’re data is automatically put into compliance with just about every HIPAA data storage regulation.
Do you use cloud-based billing software?Does your software offer an integrated EHR, or will it integrate with my EHR?Are you automatically reminded of claims deadlines and denials that need to be addressed?How do you handle payers that only accept paper claims?What are your data backup and disaster recovery procedures?
Don’t settle for less than complete transparency.
In the past, one of the most serious downsides to outsourcing your billing to a third-party was the loss of at-hand financial data required to manage your practice. Once you outsourced, you had to rely on whatever reports your biller could supply you with to determine the financial health of your practice. Practice Management had to be done forensically as the reports were historical documents by the time you received them making them useless for real-time adjustments or proactive decision making. Furthermore if CMS or some other payer suddenly decided they required a new report for reimbursement, you were at the mercy of the software vendor of the billing service to produce a custom report, which was often never-time.
In contrast, medical billing companies that use today’s cloud-based systems offer the complete opposite. You can expect 24/7 access to any claim in the queue and any data point you need (number of claims denied, days in AR, etc.). An example of reports you may require from your biller include reconciliation reports showing: Charges, payments, write-offs, adjustments, open charges, unapplied payments, posted payments – broken down by user, provider, legal entity, location, and payer. You may also want a report of unbilled superbills, superbills on hold, flagged superbills, and charges on hold. Generally, you will need:
– Charges Summary – Payments Summary – Aging Summary (A/R) – Aging Claims (by insurer) – Adjustments Summary (write offs, refunds) – Visits – Procedures – Denials – Collections activity report
Most physicians will also need PQRI reporting data and Meaningful Use reports. It is important that you verify all essential operational and practice reporting needs prior to engaging a service.
It should be clear by now that the key to successful outsourcing is a combination of experienced people with cutting-edge technology. Look for a billing company with expert and experienced employees and one that understands the value of advanced revenue cycle management software—once you have these, then simply ask the right questions.