Select Your Billing Company Carefully

By Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC

Many practices enjoy the benefits of outsourcing their billing functions, which allows them to concentrate on providing patient care. Choose the wrong billing company, however, and you may end up with even greater distractions and financial frustration.

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To be sure you choose a billing company that meets your needs efficiently—and does so compliantly—do some homework to answer the questions below:

What credentials/experience does the billing service have? For example, how long have they been in business and what is their reputation? Is the billing company registered or licensed by the state they are in, if their state requires such registration/licensing? Do they carry professional liability insurance? Do they provide a written contract for their services which spells out their and your responsibilities in this business relationship? How many clients do they have, and do they have any clients similar in size/patient mix as your own practice? Are you able to contact current and/or previous clients, to ask their opinions of the service’s performance?

Does the billing company have experience in your specialty? Does the billing company have experience and, if not, do they understand the unique factors that affect your specialty? Do they have an appreciation for the issues surrounding your coding, reimbursement, denials, and appeals? If not, do they have the resources to get up to speed, to your satisfaction, so that your revenue does not suffer?

What types of training does the staff have/receive? For example, does the billing service’s management hold a certification from a professional billing organization? Are billers/coders professionally certified? Does the service provide ongoing education and guidance for staff?

What resources does the biller provide for its staff? Are all guidebooks (CPT®, HCPCS, etc.) up-to-date? Does the service have a written compliance plan? If so (and you need to be sure it is so), can you review the plan?

Speaking of Compliance …

What is the procedure to protect the privacy of information? Does the service have a compliance officer? Does the billing company provide secure encrypted email communications consistent with Health Insurance Portability and Accountability Act (HIPAA) requirements? Does the billing company use home-based employees and, if so, what precautions are taken to ensure HIPAA compliance?

What are the company’s technical capabilities? Do they electronically process and submit claims, either directly to Medicare or through a clearinghouse? How often are claims submitted to the clearinghouse? What’s the process for third-party payers? Does the service use batch controls to minimize data entry and other errors? Will the service help your practice with forms, superbill design, office processes, etc.?

How does the biller handle claim changes? In other words, what’s their protocol for changing CPT® or ICD-9 codes if errors are discovered? What’s the protocol for missing information?

What type of financial reporting does the billing company provide? For instance, can the practice request ad-hoc reports? Can the service provide reports to determine physician compensation levels? If the practice is capitated, can the billing service report on capitated service utilization? Can your practice access billing data at its office? How robust are the month-end reports?

How is the billing company’s follow up? Specifically, how successful are they with appeals? What parameters do they use to determine if they will appeal a denial or underpayment? What kind of accounts receivable follow-up procedures does the billing service have? How often does the service follow up on payer accounts?

How much will it all cost? If the billing company’s fee is based on a percentage, is it a percentage of charges, or a percentage of receipts (the latter is better)? How are refunds handled? Are they netted out of receipts, so your practice is not paying the billing company for money returned to the payer? Does the billing service charge a start-up fee?

If the answers to any of the above questions are not to your satisfaction, keep looking until you find a billing service that meets expectations. Remember: Even though you are outsourcing, the practice is ultimately responsible for its own claims, and you need a billing company you can trust.

Experienced Staff Is Crucial

Even if the billing company is not coding for you, it’s a good idea for them to have at least one certified coder on staff. Appeals require the knowledge of a coder, and compliance also demands the increased knowledge that a certified coder can bring to the table. Even the billers need to know aspects of coding—although they do not need to be certified—to do an excellent job in billing for your practice. Key areas of education include rules and regulations, where to find the information for Medicare, Medicaid, your private payers, etc., modifiers, correct order of diagnoses, bundling and National Correct Coding Initiative (NCCI) edits, what separate procedures are, etc. You do not want a billing company that is just providing data entry.

Best Bets

My recommendation is to find a billing company with experience in your specialty, with a proven track record in compliantly optimizing practice revenue. I would not recommend entering into a billing company relationship without a written contract that very explicitly spells out both your, and their, responsibility.

compliance is no longer an option. The Accountable Care Act mandates a compliance plan for all practices, with minimum requirements to be spelled out by the Office of Inspector General (OIG). A practice cannot afford to contract with a billing company that does not have a living, breathing, and operating compliance plan in place.

I also suggest checking out the billing company’s recommendations. Talk to both current and past clients, if possible. Find out what the benefits of working with the billing company are, and what you need to make the relationship function flawlessly. Clients should be able to confirm what the company has told you during the sales phase of your relationship.

Finally, do not expect to see your full income generated by the billing company for approximately four months. It takes about that long for them to get a full queue of your billing to the payers and a revenue stream to start flowing into the practice. Make sure you keep collecting on the accounts receivable that was in process when you contracted with the billing company to keep the bank account healthy during this four-month period.


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