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For
Healthcare Providers:
What to look for in a Medical Biller or
Medical Billing Company
Medical
billing or practice management is not to be taken
lightly. We are not here to tell you that anyone can
do it. We are here to say that, as physicians, you
must choose this person or company with extra care
because your practice depends on it!
Before
you can choose a Billing Center, you need to pre-define
your goals. Some practices benefit by outsourcing
their billing to keep patient care separate from
billing and reimbursement issues. Decide first if
outsourcing your billing is indeed what is best for
you.
We don't just focus our priorities on
education of medical billing specialists, we know the importance of
the billing specialist TO the provider. We take pride in letting
healthcare providers know that WE CARE about their bottom line!
The
following are what
healthcare providers should look for:
Experience or Training:
While experience is always a plus, don't rule out
the new billing center who is knowledgeable and
continues to educate themselves. A billing center
without current clients, or with only one or two clients,
means extra time they have to spend on your
practice. Just make sure their knowledge is up to
speed in your specialty. Ask for credentials, type
of education they have accomplished and what their
future goals are for their business. Small
billing companies can offer your practice a more
personalized service! Unlike a large corporate
billing centerr who can afford to lose a few
practices, a small billing service will most like
put forth that extra effort. They want to keep your
business and, most of all, they rely on your
references when seeking new business.
Request the amount of knowledge or credentials they
have in coding. While coding ultimately should be
the responsibility of the physician, a good billing
person should be knowledgeable about coding issues
and be able to spot errors and advise on corrective
action.
Read
More Below.....
Is the
billing company HIPAA ready?
What steps have they taken to create a HIPAA
compliant policy and environment for their company?
Request references.
If references are not available, ask them if they
can give you some references from Association
Directors, teachers, course instructors, etc. If
they are a new company, references from prior
employers can give you an idea of their work ethic.
Request to see the billing company's compliance plan.
A committed billing service will have a full
compliance plan in place. This is the road map and
guide for their business and you can determine the
commitment of the billing company by looking at
their compliance plan.
Ask
questions such as
"How
will you follow up on claims?".
What type of appeal system do you have in place?
Ask
what
type of reports you will receive for your practice?
How frequently (monthly, quarterly, annually,
etc.)? Reports should consist of the following BASIC
reports:
Accounts Receivable
- aged
by either date of entry or date of service
Practice Analysis
-
overall reporting of the practice charges and
receivables
Transaction Report
-
general report of payments, charges and adjustments
Claims
Report
-
to
show claims submitted for a reporting period
Managed Care
- reports to show loss of revenue, adjustments,
timely payment and referral tracking
These are just some of the reports needed. If you
feel that there are additional things you want reported,
let the biller know and ask them if they could
provide you a sample.
Can
they track and manage managed care visits, including
capitation utilization?
(for those who are participating or interested in
participating in managed care programs)
What
type of practice management software are they
using? Can
they provide you with remote access and/or a read-only copy in the office to help you and your staff
collect the appropriate co-payment amounts?
Discuss the various types of solutions available for
accessing your account at your office. Keep HIPAA in
mind when outsourcing to a company with remote
access capabilities, your computer in your office
should be HIPAA ready and the access should be
restricted as well as maintaining compliance with
HIPAA regulations (computer log in and log off)
Are
they up to date on their coding books?
What
are their collection practices and procedures?
(i.e., do they provide soft collections, alert you
to take action on accounts needing extra attention?)
What
kind of safeguards are in place within their company
for security of data backup?
Does
the billing company have a backup company or person
that can take over in the unfortunate event of death
or illness? Ask to
see a copy of the companies policies and procedures
as well as compliance plan which should have written
documentation as to a backup policy or emergency
procedure plan.
How
can you reach them if you should need them?
Are their hours of operation consistent and can you
depend on them to be there during your regular
business hours?
What
are their fees?
If it is based on a percentage, will it be of total
practice collections or total charges billed? Do
they have a start-up fee and what does that start-up
or set up fee include? Be aware that it is
practical for a billing company to evaluate your
practice and needs before they quote you a fee for
services.
Note:some States do
NOT allow a physician to enter into a fee-splitting
arrangement with a practice management company
or any non-medical provider. This means you
should be careful about entering into a contract
with an outsourced billing company who charges based
on a percentage of collection. Also the OIG has
issued guidelines for third party medical billing
companies and frowns upon this method of
contracting.
Remember
... this is your practice and your livelihood depends
on the revenue that it brings in!
