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Ten Questions to Evaluate Your Billing Vendor

Make sure your practice gets the high-quality service you are paying for By Alina Mason

Financial success does not depend only on your physicians’ expertise. An effective and well-trained billing vendor is crucial to revenue flow. Whether you are evaluating your own billing vendor or looking to make a change, here are important questions to ask.

  1. How many of your clients share my specialty? Coding and billing is a complicated process with lots of rules that pertain to each specialty. Determine if your billing vendor has other clients in your specialty. If you are the only client, consider looking at other vendors who are familiar with the type of services you provide. Their knowledge of what you do will drive your practice’s success.
  2. Will you be working on your practice management software (PMS) or on our own software? Determine if your billing vendor will use its PMS or work with your own. Most EMR software has a practice management component already built in. If the vendor is working on your software, you will have to decide who will cover the cost of the clearing house and if there are any other fees you are picking up. If your billing vendor will be using its PMS, you will need to establish guidelines in your contract to ensure you have the rights to your billing data and reports.
  3. Are periodic audits performed? It is important to audit claims periodically to catch any over- or under-coding. The billing vendor should be able to perform quarterly audits of at least ten charts. The vendor should serve as an educational guide for physicians on any coding errors that are found.
  4. How many certified coders are on staff? Determine how many certified coders are on staff, and ask if they will be handling your account. Many billing vendors will have a couple of certified coders on hand, but hire other staff members to handle physician accounts. It is important to know who will be working on your claims, and know the level of training they have received.
  5. What is the workload of the staff on your account? Determine how many accounts the staff member assigned to you is responsible for. This will give you a clear idea of whether your account is given the proper amount of attention. If the staff member is responsible for five other physician accounts, minor errors can be easily overlooked.
  6. How often are claims submitted? The frequency of claim submittals will determine your revenue flow. Claims can be submitted daily, weekly, or biweekly. Establish set guidelines for when claims should be submitted to streamline your revenue flow.
  7. How are rejections and denials handled?
    The handling of rejections and denials will have a significant impact on future claims. Having the knowledge of what triggers mistakes with various insurance companies will set your practice on a path to improvement. If rejected and denied claims are written off without a second glance, you lose an opportunity for revenue growth.
  8. How often are patient statements submitted? In the current economy, patients have a greater responsibility for their statement balance. The sooner they receive their statements the sooner your practice will get paid for services rendered. Patient statements should go out at least once a month, but ideally on a weekly basis.
  9. Who will be responsible for handling patients’ billing questions and concerns? Once patients receive their statement, it is important to determine if the billing vendor will answer standard patient questions about deductibles, co-pays, and coinsurance. If all calls are simply routed to your practice, be prepared to have staff trained in answering billing questions.
  10. What type of reports do you provide?
    On a monthly basis, your billing vendor should provide you with a set of standard financial reports that include billable services, payments, adjustments, and accounts receivable. Find out if the billing vendor can provide you with customizable reports, which can potentially give you valuable information about denied claims, procedural codes, and various insurance companies.

Evaluating your billing vendor by asking these simple ten questions will help you determine whether your practice is getting the quality of service you are paying for. Billing vendors who are knowledgeable, efficient, and accurate will help you maintain a financially successful practice.

Alina Mason is chair of the CMS Practice Manager Section and executive director of Medical Arts Unlimited in Libertyville, Ill.

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