Evaluating Your Medical Practice Billing Company

December 30, 2011

Is it time to implement a yearly review with your medical practice's billing company?

When is it time to evaluate your billing company? It's always time. As a business owner, it's necessary to balance out where your resources (time, money, staff) are spent. There are so many hats to be worn and so little time in between seeing patients, that often the business management is pushed aside.

There are many reputable outsourced billing companies available to you. Perhaps the one you are using is one of them. But is it the right fit for the size of your business, and your overall long-term goals? Even if you are performing your billing operations in-house, you need to check-in often to ensure you are on track.

Here are a few specific areas to evaluate and review with your designated billing representative:

Billing Knowledge / Skill Set: Are you often advised on billing codes and procedures based upon specific insurance? Do you know if your billing resource continues to allow you to code for something that is never paid? Having this information at your fingertips increases your overall collections success and reduces your write offs. Is the billing staff kept abreast to all applicable policy changes from insurance companies? Do they know when they have to add any necessary modifiers? Are they aware of the rates you charge per insurance company? By assuring that your billing resource has this knowledge base, your chances of proper payment will increase significantly.

Communication: Does the staff communicate well with your staff and patients? Oftentimes, your patients will grumble about “them not getting it right.” That is your clue to listen and find out what is really happening. With the very dynamic industry we are in, insurance companies are always changing the rules. It is very important that your billing staff is willing and capable of explaining these changes or reasons of confusion to your clients. There is also a lot of opportunity for error when sending out claims to insurance companies. If your billing resource does not have all of the pertinent information, then clean claims cannot be sent, resulting in denials. The company you hire to manage your accounts is a direct representation of your practice. Make sure you are happy with that communication process.

Accounts Receivable Follow-Up: How often does your staff hear from your billing company for missing or additional information? If it is not weekly or more, then your accounts are not being paid the proper attention. A weekly list of information requests such as: authorizations, chart notes, RXs, diagnoses, confirmation of basic information such as DOB, and name, etc., must be sent to your staff, and your staff must get that information back to your billing resource as soon as feasible possible. A timeframe of one week is very appropriate. Each day one claim sits in your A/R reduces its chance of payment, significantly. Are you aware of your billing resources policy after an insurance company denies a claim? If those denials are being allowed to age out, and eventually just written off, that is a red flag for improvement.

Overall, you are responsible for your business. You have investigated and evaluated your billing company prior to signing up with them. But, as you grow, or even pare down the size of your business, is your billing company able to keep up, follow-up, and communicate? This is a business relationship and should be treated as such.

A monthly meeting with very extensive reports showcasing where your A/R is at, is a must. This is your money and you should be very comfortable knowing where it is at. You might be surprised to find out that they feel their hands are tied based upon the information (or lack thereof) coming from your staff over to them. It's a great opportunity to identify areas that can be improved in both your business and theirs.

When to know it's time to step away - over the next several weeks, we will look at the whens, whys, and hows to make the move to a new billing company.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.