Having the Hard Conversation With Your Billing Vendor

Let's face it medical billing can be very challenging. Between the insurance companies changing details of your contract without full disclosure, and patients who call and yell at the customer service reps, a day in the life of a medical biller can be very stressful. And, if your front- or back-office staff members do not reply to information requests in a timely fashion, you risk adding another stressor.

Knowing that billing is difficult to work and oftentimes has a high turnover, it's best to have a supervisor from your billing vendor available to you at any given time. You should also set up a monthly meeting to review all of your A/R accounts with this representative. The key to a good meeting is knowing what to ask for, and never finger-point. The battle between front- and back-office staff and billing staff has been going on for years. The truth is everyone is equally responsible to get your claims paid. If claims are denied due to coding issues, data-entry errors, or incorrect policy identification numbers, that's your office's responsibility. If claims are denied because they are being sent to the wrong claims address, insurance company, or the electronic billing is not set up properly, that's the billing company's responsibility. If you combine all of these issues together, and the whole lot is incorrect, its time to review your internal policies and have the billing company do the same.

The best types of questions to ask are as follows:

1. What is the A/R broken down by insurance class? (Blue Cross, Medicare, UnitedHealthcare, Worker's Compensation, etc.)

2. Where are the denials coming from? What are the reasons for the denials?

3. Are there any payers that are not paying in a timely fashion? (Often, insurance companies "drop" claims and state they were never received.)

4. What is your average payment per visit?

5. How many statements are generated on a monthly basis?

6. What advice would you provide to better our collection percentage?

7. What is your staff turnover rate? (If this is too high you have a management issue - if they can't manage their staff, they cannot manage your money.)

8. What transparency do you have internally with your staff?

9. What is the bottom line balance you will not "chase"?

10. How long does it take for a representative to call one of your patients back with a billing question?

11. What is the DSO on your account? (Days sales outstanding.)

These are all very measurable and reasonable requests and can really get you the required information, without the usual finger-pointing and blaming.  Like I said, medical billing can be a very challenging task, so by working together with the billing vendor, you can be paid quicker and more accurately.