If you have practiced medicine for any time, you will 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 streamline their operational processes in an effort to reduce expenses and increase revenue.
One of the best ways practices can increase their revenue and stay competitive in a sometimes unstable market is to outsource their billing to a third party provider. But how do doctors make sure 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’s workflow and minimize the time it takes you to get paid. And, at this time, all quality providers will have rigorous compliance programs that will ensure the security, privacy, and confidentiality of protected patient data.
But beyond these generalities that any doctor requires, what are your 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 (ie, provide all necessary documentation and authorization for services). Since using a generic contract template is problematic, 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?
The right billing partner should not only be able to handle your payments and claims, but 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 administrative policies, staffing levels, and IT resources are sustainable. How can your billing partner help you make the necessary preparations to meet future goals?
Questions to ask prospective members
What technological capabilities does it 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 providers what their experience is with EHRs, practice management systems, and whether your 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 Billing Company ICD-10 Ready?
At this point in the game, all billing companies need to be up to speed with ICD-10, there’s just no excuse not to be prepared. Ask your potential partners if they have completed end-to-end testing and if they have done the appropriate training for their programmers. Are they ready, willing, and able to handle any reimbursement issues due to denied claims?
Do any of your other clients share your specialty?
Let’s face it, coding and billing is complicated and there are different sets of rules depending on the specialty. Does your potential partner have billing experience in your specialty? If not, find someone who 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 their own? 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 clearinghouse and if there are any fees you will charge. If you will be using the provider’s PMS, be sure to establish guidelines in the contract stating that you have rights to their billing data and reports.
Will you 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 perform regular claims audits to detect any under- or over-coding. Ask them how often they do this (should be quarterly) and how many charts they cover (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 be working on your claims and what level of training they have received.
How often will they file their claims?
It stands to reason that the frequency of claims filed will determine your income stream. Claims can be filed daily, weekly, or bi-weekly. Be sure to establish guidelines for how claims should be filed to maintain cash flow.
How do they handle rejection?
While most humans handle denial of any kind pretty poorly, it’s your billing provider’s responsibility to be great at handling denials – claim denials. Your provider must be able to identify the triggers and patterns of denials and fix the problems immediately to increase revenue.
Who handles patient questions and concerns?
Not all providers take calls from their patients with questions about their deductibles and copays, so know ahead of time what your preference is. If you do not want these calls routed to your practice, please ask in advance if this is something they handle.
What types of reports do you provide?
Without a doubt, 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 screening potential partners by asking these questions will help you find the medical billing provider that will help you maintain a financially successful practice.
