Choosing a Medical Billing Partner: 6 Questions to Ask First

In my almost 30 years of experience in healthcare billing, I’ve never seen more rapid change than today. Ever-evolving laws, regulations, and new reimbursement models make it imperative for shrewd physicians and administrators to align themselves with the most astute billing professionals to keep the practice healthy.

Here are the top six questions I advise practice leaders to ask themselves before selecting a billing partner.

1.What qualifications and credentials should I look for?

The billing firm must have policies and procedures that maximize the efficiencies of practice work flow and minimize the time it takes to get paid. In the wake of the HIPAA Omnibus Rule, billing companies also must have a rigorous compliance program that ensures the privacy, security and confidentiality of protected health information (PHI).

Billing company leaders who orient their staff assiduously and support continuous education, keep their firm and your practice on the cutting edge of industry developments. For instance, billing professionals who have achieved certification in the Certified Healthcare Billing and Management Executive (CHBME) program, offered through the Healthcare Billing & Management Association (HBMA), demonstrate a biller’s commitment to further their education.

 2.What stipulations are essential to include in a contract?

An effective contract clarifies the billing company’s scope of work in detail, while specifying your practice’s responsibilities and pledge (e.g., to provide sufficient documentation for billing and authorization for services). Individual stipulations may vary from firm to firm, but should always contain the legal names of responsible parties, effective dates (including termination clauses), service reimbursement parameters, and an explanation of how reimbursements will be calculated, along with compliance requirements and scope of work. As always, whenever entering into a contract, seek legal counsel and do not be tempted to use a generic template as your final contract.

3. How can the billing partner help measure the health of my practice?

As reimbursement models continue to evolve, you will rely on your medical billing company to provide you with expert counsel in evaluating not only the health of your organization today, but also to make the appropriate preparations to meet future needs. Choose a billing company experienced in evaluating reimbursement data analytics, as well as one that can assess existing administrative policies, staffing levels, and IT resources so your practice can focus on what it does best- providing quality patient care.

4.What technological capabilities can I expect from a billing company?

Today, billing companies do much more than reimbursements. With their breadth of knowledge and expertise, billing companies may counsel you on the best technology to meet both your needs and regulatory requirements. Their experience with EHRs, practice management and billing systems, and other IT solutions, allows billing companies to integrate systems effectively, regardless of where they originate and reside. Whether you are looking for a new implementation or looking for an upgrade to your existing IT solution, the right billing company will be able to help zero in your focus of certified, respected vendors who have stood the test of time in meeting the clinical, administrative and financial needs of medical practices.

5.How important is it for the billing company to be "connected" to the revenue cycle management industry as a whole?

Because the business of healthcare billing is changing so rapidly, it is critical to partner with a billing firm that is playing an active role in the revenue cycle management industry and is constantly adding to its knowledgebase. You will want to investigate how the billing company is staying current with things like the transition to ICD-10; the use of PQRS (Physician Quality Reporting System) to make quality reporting pay; the types of relationships they have with your local payors; and how they stay abreast of regulatory changes that affect compliance and reimbursement.

As one example, the HBMA is a 700-member strong organization of billing companies that offers numerous educational programs to help members to stay on top of legislative, regulatory, and coding changes.

6.Since ICD-10 is one of the most significant changes the physician community faces, what preparation should I expect from a billing company?

Practices that aren’t prepared for the transition from ICD-9 to ICD-10 may see an immediate hit in revenue on Oct. 1, 2014. It may even serve as a death blow for some. Savvy practices will rely on billing companies that have completed end-to-end testing and have already performed the appropriate training for certified coders and are armed and ready to act in the event reimbursement issues arise due to adjudication issues with payors. This means they are keenly aware of which reimbursements should be based upon contracts, and evaluate any changes in denials or reimbursement trends. These efforts build upon an organization’s ICD-10 proficiency and work to ensure that reimbursement continues to flow to your practice.

Covering the above questions will help you find the best billing partner to help your practice thrive today and remain competitive in the future. But, I'm interested in your thoughts - beyond these six, are there additional questions or areas that should be included? Let me know in the comments section below.

Sherri Dumford, CHBME, MBA, is director of operations and external affairs for the Healthcare Billing and Management Association (HBMA). An established industry veteran, Dumford has worked in healthcare billing for more than 30 years, which includes serving as past president for HBMA. In her current role, she supports all aspects of the HBMA’s daily operations relative to membership, advocacy, and education, in support of HBMA strategic initiatives.E-mail her here.