Wiki Billing Questions during a Practice Acquisition

[kwhite2008]

In your experience, what are some good billing questions to ask during a practice acquisiton?
So far, here are some that I have thought of:

How many providers do you have?
What Practice Management system do you use?
Do you use a clearinghouse or submit directly to the payer?
What types of facilities do your providers practice in?
Are all of your providers credentialing for billing?
How do you verify insurance eligibility?
Do you post electronic payments? If so, what percentage?
Are there known denial trends?
What are the providers coding skills/experience?
Do you have a self-pay policy?
Do you offer payment plans?
Do you practice under one tax ID?
How do you handle patients in collections?
Do you use a collection agency?
Do you bill for labs and have a Medicare CLIA number?
Who are your top payers?
How often are patient statements generated?


Thanks!

 

[Pam Warren]

Off the top of my head.....

Have you ever been audited?

What are your days in AR?

Do you perform external coding/billing audits per the OIG?
If so, what were your results?

What are your billing trends (bell curve data)? for example, are they billing to the right of the bell curve (lots of higher codes), or are they one-code-wonders?

What's your payer mix?

What services do you provide? Where are they provided? (diagnostics, off-site services, etc).

Have your hospital priveleges ever been suspended?

What's your ratio of clinicians to administrative staff?

and most importantly.....do you employ credentialled coders?

 

[jimbo1231]

A Couple More

Good questions. And I agree with Pam's additions. In terms of practice metrics, I'd want to see at least 3 years of practice management reports. These would include month end billing reports (Chgs/Payments/Adjustments by payor); at least a years worth of Aged Receivables reports by payor; and CPT by provider for at least a year.
As part of due diligence I'd also want to see all their manged care deals. Don't want to get strapped with a practice that has made some bad deals that your practice will inherit.
Also if they are outsourcing any coding/billing etc services.

Jim S.