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

§  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

§  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.

When contracting with an outside billing service, minimize your risk through the following measures:

• Request a copy of the service's compliance plan;
• Determine if the billing service has ever been investigated for fraud and abuse;
• Ask if the service has periodic audits performed by an outside auditing firm;
• Request three references of current clients, and call the clients to ask if they are satisfied with the company;
• Inquire about the qualifications of the service's billing staff;
• Request a list of the standard financial reports that the service gives its practices clients, and
• Ensure that the service has insurance coverage for errors and omissions.

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!