September 24, 2014
Six Factors to Look for in a Billing Company

If you’re looking for a new billing company, the number of options can be overwhelming. Even if you’ve networked at conferences, asked others for recommendations, and searched online for glowing (or galling) reviews, it’s often hard to differentiate fact from anecdote. Here are six areas of focus to help narrow the list of prospects down to the billing company that’s right for you.

1. Compliance and credentials

The most recent HIPAA Omnibus Rule dictates that coding and billing companies rigorously protect and control personal health information, as “some of the largest [data] breaches reported to HHS have involved” such third-party contractors. Penalties noncompliance, based on the level of negligence, have been increased to a maximum of $1.5 million per violation. That’s quite the impetus, but don’t rely on the government’s threats alone to protect your patients’ data: Ask them to describe the policies and safeguards in place to achieve compliance. Does the company self-audit? How often? Is employee knowledge periodically tested as well?

Ask about the percentage of staff that has achieved certification in the Certified Healthcare Billing and Management Executive or Certified Professional Biller programs, and how the company encourages continuing education. The ins and outs of coding and billing change annually — not to mention the imminent conversion to the ICD-10 system. It’s important that your billing company is equipped to advise you on how to keep up, and not the other way around.

2. Detailed data

Healthcare is increasingly data-driven, and a good billing company will understand that and be able to supply data quickly. Three months is too long to wait to know you have to change documentation practice — by that time, you might have lost tens of thousands in potential reimbursements. Ask whether their processes for delivering the information you need are automated. Specify in the contract what data you’ll be receiving — e.g., key performance indicators, days in A/R, revenue benchmarks — and how often (typically monthly).

3. Mechanism for denials

Ask a prospective billing company about their track record with denials. What are the collections and denials rates? What are the mechanisms in place to prevent denials in the first place? Will they follow up when an operative note is unclear, or there’s a gap in an emergency department visit? Know what happens when a denial does occur, and what your role will be in helping secure a successful appeal. A billing company should take on the bulk of the work involved in winning appeals when they do happen.

4. Technological capabilities

In addition to ensuring the data you transmit will be safe, ensure the billing company is technologically capable of working with your EMR/EHR system. Ask for a demo of how the company’s IT system will integrate with yours, and know how much work will be required by in-house staff to share electronic files. The last thing you want after go-live is to find that the company can’t start the coding and billing process because documentation can’t be accessed.

5. Staffing and workload

Outsourcing billing operations should free in-house “staff to schedule patients, control the demographics and manage patient co-pays and payments, while the third-party company manages more of the traditional ‘back-end’ operations.” Decide whether you’d prefer that the contracted billing staff work in your facility/office, or off-site — some companies will let you choose. You can also decide whether a portion or all of your billing will be outsourced; it might be that you need specialist help for a new service line, or somewhere to send work when there’s too much. Determine what will be most cost-effective for your facility or practice, and seek a billing company that meets your requirements.

6. Specialization

Companies can specialize in physician practices, outpatient surgery, diagnostic services — the list goes on. A billing company that understands the nuances of your business may go beyond the benefits of cost- and time-efficiency to provide better reimbursement rates and lower denial rates. Ask whether specialized staff will be available and/or equipped to handle various service lines, or the specialty in which you operate.

Remember that contracting with a billing service is a relationship that goes beyond the contract. The company you choose should be a partner that aims to not only make your business successful, but also makes you feel comfortable and confident in your choice.