The Best Company For the Job

Billing companies often try to convince physicians that outsourcing their billing is the only way to go; claims scrubbing, denial follow-up, resubmissions… all that red tape taken care of -- and out of your hair. But, rest assured nothing is perfect. For example, your practice will still need to collect patient demographics -- a common component when tracking a trail of billing errors.

Nevertheless, other reputed benefits of outsourcing, such as reduced staffing needs and improved compliance, can be real. It all depends on the quality of the billing agency you select. But, here’s what’s often left unsaid: You should regard your billing company as a business partner who will work with you to ensure your success. They cannot handle your practice billing independent of your input. In fact, HIPAA formalizes this relationship through a required business associate agreement.

To ensure the best possible relationship between your practice and your billing company, here are some factors and questions to consider when searching for a potential billing company:

• Experience

• How long has this billing company been in business? A billing service that has only been in business a short time may have more time and resources to devote to your practice, but it 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 indicative of the company’s commitment to compliance and coding accuracy. They 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; you don’t want your claims lost or overlooked by a company whose staff is stretched too thin.

• Technology

• 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 and/or EMR;

• Provide remote access to accounts and reports;

• Have a claims edit function that catches mistakes before they’re submitted to carriers; and

• Not be proprietary software.

• How many claims are submitted electronically? Electronic submission, which is available from all major payers, greatly enhances efficiency. Your chosen billing company should be submitting a significant percentage of its claims electronically. If this company is not realizing the efficiencies of up-to-date technology, then neither will you -- and that will cost your practice in lost revenues.

• 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.

• Problem Solving

• What protocols does this company have to fix errors? There must be a protocol for changing CPT and ICD-90CM 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 backup and 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. Clear expectations should be set for following up on unpaid, underpaid, and rejected claims, as well as for regular reporting.

Finally, here’s one last way to make sure your billing company works as hard for your money as you do: compensation. Make sure you contract to pay for services based on a percentage of collections, rather than actual charges. That way, you’re only paying the billing service for what it brings in for you.

Karen Zupko is a seasoned senior advisor who has been helping physicians to navigate America’s healthcare system since 1974. Her perspective stems from more than 25 years of consulting, coaching, and training experience with physicians and those who manage them. She is a member of the American Marketing Association and Women in Communications, and has served on the board of trustees of Chicago's Grant Hospital. Karen is a graduate of the University of Kansas and a Chicago native. You can contact her at kzupko@karenzupko.com.