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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, however here to say that, as physicians and other healthcare providers, you must choose this person or company with extra care because your practice depends on it!

Before you can choose a medical billing company or medical biller, you should pre-define your goals for your practice. Some practices benefit by outsourcing their billing to keep costs down and increase time spent on actual patient care. Decide if outsourcing your billing is indeed best for your practice.

We do not just focus our priorities on the education and resources for 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, especially in these very uncertain times where healthcare is rapidly changing.

The following is just some of the things you should look for in a billing specialist or medical billing company.

  • Experience and/or training: While experience is always a plus, don't rule out the new medical billing company or specialist that is knowledgeable and invested in ongoing and continued education. A billing company with a small client base could also mean extra time spent on your practice needs. Ask for their credentials, type of education they received, and are they committed to ongoing and continued education. Larger is not always better, a small billing company to outsource to could provide your practice with more personalized service. A small medical billing company will usually work harder to keep your practice in good health.

  • Coding:  While coding is ultimately the physician's responsibility, and can often be seen as a separate service, a good medical billing specialist or company will have a general knowledge about coding issues to be able to spot errors and make recommendations on coding changes. If the billing specialist can handle the coding, it's a good idea to make sure they have the proper certification to do so. Although coding certifications are not mandatory, it is a good idea to require a coding certification such as from the AAPC. (CPC)

  • Offshore medical billing companies/services -  are you looking at the possibility of hiring a medical billing company outside of the United States? If so you should be aware of all the potential legal problems that can arise from doing business overseas. Also consider your patient's wishes as well. You are welcome to view our medical billing company listings at We make all efforts to be sure only medical billing companies in the US are listed. In fact we do not accept any offshore companies at all.

  • HIPAA Compliance: If considering an outsourced billing company, what procedures are in place in their services and facility to adhere to all HIPAA and state regulations on privacy and security.

  • References: If employer or client references are not available, ask them if they can give you some references from association directors, teachers, course instructors and the like.

  • Compliance Plan - While third party billing companies are not required to have a compliance plan, we completely recommend our billing companies not only have one, but maintain their plan and procedures in regards to compliance.  A good billing company should not have a problem letting you look over this compliance plan and procedures.

  • Data Security - You will want to know your data and/or access to your data is safe. Inquire about the security of the data backups. Ask the billing company if they provide full backups both on and offsite. What policies are in place in such cases where data may need to be captured or restored.

  • Claims follow-up procedures - Ask the billing specialist or billing company what their procedures are for following up on claims. Also ask about such things as denials, appeals, resubmissions, secondary and tertiary claims.

  • Reports - What type of reports will a billing specialist or company provide you with? Will they give you any special custom reports you may require? Can they meet those reporting needs?  Some of basic reports you should be able to receive are; accounts receivables, practice analysis, transactions, and claim status reports.

  • Managed care - Is the billing specialist or billing company able to provide services in regards to managed care such as obtaining authorizations, alerting the provider or staff, of a need for a new authorization, and notifying the provider or staff how many visits are left on an authorization.

  • Practice management software/system - You will want to discuss the solution available by the billing company to meet your practice needs. Will the billing company be able to utilize your current practice management software/system? Will they be able to adhere to any and all HIPAA privacy and security regulations in establishing a networking communication with the existing practice management system. Do they have their own software/system in place if that is a better option for your office. A good billing company will be able to ease your concerns regarding software and utilization of their system or yours.

  • Policies and procedures - Discuss the policies the billing company has adapted that would take place in case of emergency, vacation time or any other situation that comes up. A good billing company should have procedures in place in case of an emergency or for time periods when they may be unavailable. You will also want to know the availability of the medical billing company. Will they be available to both your office and the patients? If so what hours of operation will they utilize and will they have a separate number for patient inquiries?

  • Specialty claims - If you are a practice of a particular specialty you may want to inquire as to the experience of the medical billing company in that specialty. Find out if they are able to give attention to such claims as personal injury, workers compensation and auto insurance claims. In some instances it is preferred to have a billing company particularly knowledgeable about a specific specialty.

  • Fees/Services - Discuss the billing company's contract to go over such things as fees and what is included with those fees. If the billing company is charging X%, find out if that is X% of full practice revenues or is it only for insurance payments. The contract should spell out exactly what fees are for what services. Another example is a per claim fee. If the billing company will charge per claim, you will want to discuss the definition of "a claim" and it should be spelled out in the contract.  In some states it is illegal for a healthcare provider to enter into any fee-splitting arrangement and in all cases a contract based on the practice revenue's is defined as a fee-splitting arrangement. Make sure you are not in a state that prohibits your practice from entering into such a contract that could violate state law and put you at legal risk. Keep in mind that although some states do not prohibit these types of contracts, the OIG has put forth guidelines for third party medical billing companies and does indeed frown upon the sharing of revenue.

In summary, minimize your risk in hiring a third party medical billing company through the following measures:

  • Request a copy of the company's compliance plan to look over.

  • Determine if the billing company has ever been investigated or convicted of any fraud/abuse

  • Ask the billing company if they provide any type of periodic quality assurance audit's.

  • Request at least three references of either current or past clients, associations, or training programs where certification was earned.

  • Inquire not only about the company owner's experience but if there is staff you would like to know the background and experience of the billing staff.

  • Request some sample reports.

Remember...this is your practice and your livelihood depends on the revenue it brings in!

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