Outsourcing to a billing company can help a frazzled physician, but your practice will still need to collect patient demographics — a common source of billing errors. Still, you will enjoy reduced staffing needs and improved compliance.
If you do decide to outsource, regard your billing company as a business partner who will work with you. It cannot handle your practice billing independent of your input.
Here are 10 questions to ask when thinking about outsourcing:
How long has this billing company been in business? A billing service that has only been in business a short time may not have the necessary experience and relationships with payers to collect on complicated claims. Experience of two years or more is ideal.
How many certified coders does this company have on staff? Certified coders are typically more discerning in reviewing denials and downcoding, and more articulate in launching appeals. Be sure to ask whether the certified coders are employees or independent contractors.
How many medical practices in your specialty does this company service? If yours is, say, the only dermatology practice handled by this particular billing company, it’s possible that the company will lack specialty-specific knowledge about the rules, modifiers, and bundling that contribute to collections success in the world of dermatology. Also ask about the staff-to-physician ratio.
What technical capabilities does this company have? The software used by your billing company should:
- be able to handle up to 100 carrier payment schedules for each client so that underpayments can be caught;
- allow for data transfers and remote access;
- be compatible with your office scheduling program and EMR;
- provide remote access to accounts and reports;
- have a claims edit function to correct mistakes before they’re submitted to carriers; and
- not be proprietary software.
Does this company take advantage of electronic remittance? Medicare and the largest national carriers offer electronic remittance. A proven time and money saver, this offering indicates that a prospective company is technologically savvy, efficient, and cost conscious.
What protocols does this company have to fix errors? There must be a protocol for changing CPT and ICD-9-CM codes when claims data errors occur. If a billing service changes codes without your approval, then you will be left with all of the risk and none of the assurance that the codes are correct.
How many account representatives will be assigned to your practice? You should have one specific account representative assigned to you, and a clear plan in place for providing coverage during the rep’s absence.
Does this company have clearly defined policies to follow up on unpaid, underpaid, and rejected claims? Some billing services do not begin to follow up until 45 days have passed. This across-the-board policy can cause some claims to time out if a certain payer has earlier filing deadlines.
Can you pay for services based on a percentage of collections, rather than actual charges? That way, you’re only paying the billing service on what it brings in for you.
Karen Zupko is a 35-year veteran practice management consultant. She can be contacted via kzupko@karenzupko.com.
This article originally appeared in the May 2009 issue of Physicians Practice.
