What to Look For When Evaluating a Medical Billing Vendor for Your Practice

If you've been practicing medicine for any amount of time you will probably agree that the healthcare industry has become incredibly complex in the past few years. Thanks to ever-evolving regulations and shifting reimbursements models, doctors are forced to streamline their operational processes in an effort to cut expenses and increase revenue.

One of the best ways practices can increase their revenue and stay competitive in a sometimes-shaky marketplace is to outsource their billing to a third-party vendor. But how do doctors ensure they select the right partner?

First by asking themselves a series of questions, and then asking their prospective partners another series of questions.

Questions to Ask Yourself

What are My Particular Pain Points?

Any billing company worth their salt will have policies and procedures in place that will maximize the efficiencies of your practice's work flow and minimize the time it takes you to get paid. And, at this point in time, all quality vendors will have strict compliance programs that will ensure security, privacy and confidentiality of protected patient data.

But beyond these generalities that any physician requires, what are your particular challenges or issues 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 will be more easily able to 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 outline the vendor's scope of work clearly as well as your responsibilities (ie provide all necessary documentation and authorization for services). Since using a generic contract template is asking for trouble, get some legal advice and determine your requirements: effective dates, termination clauses, compliance requirements, service reimbursements 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, they should also be able to counsel you and evaluate the health of your practice. Ask yourself what kind of assistance you need to determine if your current admin 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 Prospect Partners

What Technological Capabilities Do You Offer?

Good billing companies offer more than help with claims and reimbursements, they have a breadth of knowledge when it comes to the best technology available to meet your needs and regulatory requirements.

Ask vendors what their experience is with EHRs, practice management systems, and if their solution can integrate into your existing systems. Remember, technology is multifaceted and should help you meet the clinical, administrative AND financial needs of your practice.

Is the Billing Company ICD-10 Ready?

At this point in the game, all billing companies should be up-to-speed with ICD-10, there simply is no excuse to be unprepared. Ask your prospective partners if they have completed end-to-end testing and have performed the appropriate training for their coders. Are they ready, willing and able to handle any reimbursements issues because of denied claims?

Do Any of Their 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 experience billing for your specialty? If not, find one 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 vendor have their own? Most EMR software has practice management components built right in. If the vendor is going to be working on your current system, inquire who will cover the cost of the clearing house and if there are any fees that you will be picking up. If you will be using the vendor's PMS, be sure to establish guidelines in the contract that states you have the rights to your billing data and reports.

Will They Perform Periodic Audits?

One of the biggest threats to a practice's cash flow is complacency. For this reason it's important your vendor fulfills periodic claims audits to catch any under- or over-coding. Ask them how often they do this (should be quarterly) and how many charts they cover (should be no less than 10).

How Many Certified Coders do They Have on Staff?

Inquire 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 your claims and what level of training they have received.

How Often Will They Submit Your Claims?

It stands to reason that the frequency of claims submitted will determine your revenue flow. Claims can either be submitted daily, weekly or biweekly. Be sure to set the guidelines for how claims should be submitted to keep your cash flowing.

How Do They Handle Rejection?

While most human beings handle rejection of any kind rather poorly, it is the responsibility of your billing vendor to be great at handling rejections – claims rejections. Your vendor must be able to identify triggers and patterns of denials and fix the issues immediately for revenue growth.

Who Handles Patient Questions and Concerns?

Not all sellers field calls from your patients when they have questions about their deductibles and co-pays, so know ahead of time what your preference is. If you do not want to have these calls routed to your practice then ask up front if this is something they handle.

What Kinds of Reports Do They Provide?

You should, without question, receive monthly financial reports from your vendor that include payments, adjustments, billable services, and accounts receivable. Also, find out if they can provide you with customizable reports, which can give you targeted data about denied claims and procedural codes.

Knowing your exact needs and then evaluating prospective partners by asking these questions will help you find the Medical Billing vendor that will help you maintain a financially successful practice.