One of the reasons we opened National Revenue Consulting was because we saw healthcare professionals who loved seeing patients but could not find the time or energy after a full day to manage the billing. Among other things, they also struggled with outsourced services and always had to manage those partners. Our number one commitment is to help healthcare practices manage the process and provide regular data on claims, resubmissions, coding concerns, and revenue.
If you are considering switching billing partners, consider the following questions to really understand what you need from a billing company and if the firm you are evaluating will be a good fit.
Details about your practice & current revenue cycle management process.
- Practice details, types of patients you serve, # providers?
- Do you currently track and trend your revenue?
- Do you have a list of the most common codes billed and collections based on % charges?
- What insurance companies are you contracted with?
- What mechanism do you use to submit claims? Paper? Electronic through a clearinghouse? Electronic through an insurance company’s online billing/claim system?
- Where do you receive your explanation of benefits? Do they go to an electronic health record or clearinghouse? Do you get them via paper in the mail?
- Where are you posting payments? When you get paid for a claim, where or how is this being recorded? Do you track and trend denials? How are denials handled today in your practice?
Our recommendation is that you are able to track and trend data each month so you know how much you are getting paid per month. If revenue it isn’t lining up with what you are billing there may be coding issues that need to get addressed.
What level of service are you looking for and can the company you are evaluating provide that level of customer interaction?
- Are you looking for a personal touch or do you want a more hands-off approach?
- How often is the biller communicating regarding resubmissions and coding concerns?
- Who will your contact person be and how often do you want to have a touchpoint?
- Having a team that can meet your needs is critical to a good relationship.
Determine your communication style?
- Do you prefer communication by email, text, or a regular phone call or office visit?
- How long can you expect your billing partner to get back to you? Within 24 hours? 48? Weekends and evenings?
- How will your biller resolve issues with coding, claims, and documentation? Will you message through a secure system or have to be doing phone calls?
What other services does the billing company offer and which services would you like to incorporate into your practice?
- Will they determine eligibility and benefits prior to patient visits? How do they communicate the information to your front office staff?
- Do they help identify patient deductibles and how much has been met already? This can save you a lot of time and money from errors and denials. This also helps decrease time on the phone for your staff.
- Do they re-check patient deductibles?
- Do they offer other software solutions should you need things like collections or credentialling?
- What types of service packages do they offer to help keep costs down?
- Do they call clients and help manage patient balances or help patients with payment plans?
- Does the billing company offer a billing audit to show you where there was lost revenue and if a claim had been submitted incorrectly?
How do they share claim information and on what frequency?
- Do they send the claim information through an electronic health record, fax, or email?
- How often do they submit claims? How often do you get paid?
- If they aren’t submitting often enough it can delay your payments. This will also depend on the insurance company’s billing cycle and making sure submissions are in line so you get paid quicker.
What does the billing company charge?
- Some billers charge by the hour and others by a flat rate pre-claim (can be anywhere from $5-25 per claim). Most billers charge by a flat fee per claim (anywhere from $5-$20 and others by % of claims received. You will want to do the math if a flat rate claim. Others by the hour.
- You want to partner with a company that is motivated to improve your denials and revenue.
Considering the information above will help you determine the right fit for your practice. One size will definitely not fit all. You have to consider what you are getting for the money and know the value of the service. It’s not enough to just submit a claim, the billing company must often chase down denials and should provide you regular data to support your practice and grow your revenue.
Take away actions – take this list of questions and work through your thoughts on what you need ideally before reaching out to new billers. If you aren’t happy with your billing service, reach out 2-3 months before your next contract expires. Setting clear expectations with what you need, and what you are struggling with will help identify the right outsourced partner. The end goal is that your biller is managing the process and supporting it with data. You shouldn’t be chasing down missing claims and resubmissions.
If you’re tired of feeling like you are always having to manage your billers, come work with us!
Contact us today for an introductory Call.
