Looking for a Consultant? Consider This

by Deborah Grider, CPC, CPC-H, CPC-P, CPC-EM, CPC-I, CCS-P, CCS, CCS-P

What are the benefits of hiring a health care consultant? A health care consultant brings measurable accountability, scheduled timelines, and low costs to achieve an answer that can prove more financially sound than in-house efforts. Before you hire a health care consultant, it’s important to have a clear understanding of what you are hiring him or her to do. A health care consultant should assist with the following:

  • Managed care contract review
  • Employment contract review
  • Practice start-up
  • Review of coding and reimbursement systems
  • Medical record chart audits
  • Accounts receivable reviews
  • Medical staff issues
  • Operations overview

With a consultant’s duties in mind, what’s the best way to find one? You can find a consultant using the following resources:

  • Referrals from friends: This is probably the best resource.
  • State and county medical societies: These are great local resources.
  • Residency programs: Residency programs use consultants to assist them with developing and presenting their practice management curriculum.
  • Professional journals: Frequently, consultants write or contribute to articles published in professional journals.
  • Professional associations: Make note of who writes articles for professional journals, makes presentations at conferences and in workshops, and who the members of consultant sections might be.
  • Referrals from attorneys: Attorneys encounter consultants and their work quite often.

When choosing a consultant, find one that is reputable and fits your needs. The most valuable asset of a health care consultant is his or her reputation. Unprofessional conduct quickly puts a consultant out of business. Judge your own consulting candidates by their reputations. Factors to consider are:

  • Size: Bigger isn’t always better and there are pros and cons to working with both large and small firms. A large firm may have specialty departments to address such issues as coding, billing, practice management, etc. One disadvantage is a client may not work with the same consultant over a period of time. The project or job may be assigned to a consulting “team.” A smaller firm can provide a personal touch to the relationship with the practice; however, it could also fall short on capabilities.
  • Stability: Although longevity doesn’t always reflect quality, it’s a good idea to ask how long a firm has provided consulting services.
  • Location: Most consulting firms require the client to pay the consultant’s travel expenses to the practice or facility. Most clients prefer to work with firms located within their geographic regions. Depending on the types of services the client requests, this might not be an option. In some cases, it’s not practical to choose a firm providing services nationally when the problem to be addressed is regional.
  • Qualifications: Is the consultant qualified to perform the service? A medical record auditor should be a certified coder either with AAPC or AHIMA. Does the consultant have the expertise to perform the service? Experience and background are important.
  • Availability: Questions you can ask yourself that are indicators of the consultant’s availability are: “Were you able to speak to someone right away?” or “Was your phone call promptly returned?”

When making the initial call to a firm, ask if the phone consultation is free. Most firms realize the marketing potential of providing a free initial assessment. How potential clients are treated during initial encounters serves as a barometer to the tone of the professional relationship. If a consultant is overly-subscribed, they will not have time to give the practice the attention it deserves.

Find out if the consultant is the person assigned to work with your practice or facility, or if the project will be assigned to someone else within the firm (for example, a less-experienced associate). If the majority of work on the project is handled by someone else, it is not necessarily a bad thing. The benefit is that the client may receive quality work at less cost. However, the firm should disclose this up front, so there are no disagreements as the project progresses.

If someone else in the firm is assigned to the project, make sure he or she is qualified to perform the project’s scope. Sometimes, large firms hire less qualified staff to work under a more experienced consultant.

Needs Analysis: Describe the practice or facility needs to the consultant. Be sure he or she understands the expected results.

The consultant should ask probing questions, help the potential client, and clearly describe the state of affairs. To have a successful relationship with the consultant and a favorable outcome, clear and accurate communication is essential.

Specialty Experience: Does the individual or firm have experience in working with the specialty and to what capacity?

Fees: How does the consulting firm charge for its services? Some firms bill by the hour and others quote clients with a flat rate for a service (e.g. contract review or coding audit). How does the firm expect to be paid on retainer or in one lump sum? Are payment plans available? Is the client required to make a down payment with balance due at the conclusion of the engagement? The hourly rates of firms vary widely.

If the consultant has to travel to the facility, what expenses will be billed; for example, if airfare is covered, does this mean coach, first class, or stand-by? Is the practice or facility expected to cover lodging, meals, ground transportation, and long-distance phone call expenses.

The consultant should clarify what follow-up services are billable; for example, if the consultant  returns to the practice for additional staff training, is it an additional charge or is it covered in the initial fee? Find out the same information for telephone consultation and written reports.

Interest Conflicts: Does the consulting firm have a vested interest in a particular product, such as a software program? If it does, that should not necessarily disqualify it. If the firm is aggressive about promoting a  product, the consultant should also provide other similar products for the practice or facility to consider.

Check References: Ask the consultant to provide the practice or facility with references. Refusal to provide appropriate (or any) references, is a red flag.

Speak with the person who worked closely with the consultant. In many cases, this will be the practice manager or administrator, not the physician.

Ask Questions

Sample questions to ask references:

1. What type(s) of service(s) did the consultant provide?

2. Was the project completed within the estimated time frame?

3. Did the consultant adhere to the estimated costs?

4. How accessible was the consultant?

5. Was it easy to get answers to questions?

6. How did the consultant (if service was provided on-site) get along with personnel?

7. Was the consultant available to help implement recommendations?

8. Was the consultant willing to provide follow-up assistance? If so, was there an additional charge?

9. Would they work with the consultant again?

10.Would they recommend the consultant to a colleague?

After a complete request for proposals (RFPs) and request for quotations (RFQs) from two or three firms with checked references, the client should make a final decision.

Formally engage the consultant’s services with a contract, letter of agreement, or prepared statement of work that defines the agreed terms. Typically, it is the consultant’s responsibility to prepare this document. Both parties should sign the document.

Request for Proposal

Ask the consultants to provide the practice or facility with the following information in writing:

  • Detailed description of the process to be undertaken for your practice
  • Description of desired outcome
  • Anticipated timeframe for completion of the project. Clearly spell-out expectations if the project is not completed within the proposed timeframe.
  • Billable charges
  • Estimated fee for completing the project. Clearly spell-out expectations if the project is going over-budget.
  • Provisions on what will be done if the client is not satisfied with the final results.

It’s Your Responsibility

As a client, you are responsible for the consultant’s relationship with your practice or facility. To help smooth both parties’ transition when hiring the consultant(s):

1. Prepare the staff and physicians for the arrival of the consultant(s). If the project involves working on-site, the presence of a consultant may feel imposing to staff members, especially if they are unaware of problems existed in the practice.

2. Cooperate with the consultant. If relevant practice information is requested, comply; for example, while conducting a reimbursement audit, a consultant may want to review many years of insurance payment history. Also, it might be necessary to pull medical records to review documentation. Assign a key staff person to be the consultant’s on-site contact.

3. Request ongoing progress reports. The consultant should provide updates about how things are going.

4. Listen to the consultant’s recommendations with an open mind. If the practice does not agree, you should discuss this with the consultant early on. The advantages a consultant brings to the situation are expertise and objectivity.

5.Implement the consultant’s recommendations with a positive attitude. Impending change is daunting. An optimistic outlook conveyed by the practice’s leadership can go a long way to motivate the rest of the staff to make progress.

6. Poor communication is the most frequently-cited cause of relationship deterioration with unfavorable results. The client should make sure there is good communication with the consultant(s). Consultants want to do a good job for their clients and should be willing to work with the client.

7. The best protection is to clearly spelled-out everything in writing before hiring the consultant.


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