When and How to Select the Right Medical Billing Service

Transcription

1 When and How to Select the Right Medical Billing Service?? By Kathy McCoy, MBA $?? $ $$ A Resource Provided by Medical-Billing.com

2 Table of Contents About the Author 3 Why Consider a? 4 Types of s 9 How to Evaluate a 16 Key Criteria Resources 33 Medical-Billing.com serves more than 500 practices nationwide. Entrust Your Medical Billing to the Experts Medical-Billing.com 2

3 About the Author Kathy McCoy, MBA, has written on practice management and revenue cycle management for more than 5 years for leading medical software, medical marketing and medical billing companies. She has more than 17 years of experience in continuing medical education, developing programs with respected educational institutions including Columbia University, Johns Hopkins, and Cleveland Clinic. Ms. McCoy can be contacted at kmctustin@gmail.com Kathy McCoy, MBA 3

4 Why Consider a Why should you use a medical billing service for your practice? The answer depends on several factors, including: 1. Your specialty 2. Your practice s financial performance 3. The difficulty of finding and hiring qualified internal staff in your area 4. Internal abilities to handle upcoming challenges such as CMS audits and ICD-10 coding Because practices are being squeezed more and more by reduced reimbursements, rising costs and new regulations, a highly efficient revenue cycle is more important than ever to medical practices. 4

5 Why Consider a Medical Billing Service Essentially, there are two options for handling medical billing: 1. In-house medical billing staff 2. Medical billing service Many practices handle the medical billing process completely in-house; others handle some parts in-house and hand it off to a medical billing service at various points in the process. Still others ask a medical billing service to take full control of their revenue cycle management process. Many people feel the medical billing service option is one that makes more sense now than the in-house option, for several reasons including the level of training now required, audits, increasing denials, and more complex coding. Before medical billing and coding became more complicated, building an internal medical billing team was simple. The doctor hired a nice woman to handle his front office, and then asked her to take on the medical billing as well. There wasn t that much to it, and someone with simple training could handle the basics. Image courtesy of Stuart Miles / FreeDigitalPhotos.net. And even if the person didn t have previous billing and coding training, they often learned quickly and became fairly expert. People grow you hear the stories about someone who started as receptionist and ended up as practice manager. Those stories are wonderful, and we all love to hear them. 5

6 Why Consider a Medical Billing Service But there s the flip side: the woman who is hired for the front desk is asked to handle the billing and she is soon in over her head. There s no one with the time or knowledge to give her much training. And with little to no training, she s forced to work things out on her own as the practice revenue declines, denials pile up and appeals go nowhere. It s not the staff member s fault; he or she is following a model that worked in the U.S. for a long time. But now, things have changed and revenue cycle management needs to change with the times. Entrusting your practice revenue to an amateur is even less wise in today s environment. Entrusting your practice revenue to an amateur is even less wise in today s environment, when you re dealing with: An increasing threat of CMS audits Increased denial rates requiring more and better appeals Heavier patient responsibility that leads to increased patient collection efforts And of course, looming over it all: ICD-10 Taking all of these factors into account, you can see why it may be time to reassess the benefits of using a medical billing service. 6

7 Types of s When evaluating medical billing services, keep in mind that there are several types of medical billing resources that have developed due to the increasing complexity and importance of medical billing. It s very important to select the right type of medical billing service for your practice. These types include: Solo or Kitchen table billers Medium-sized billing services National firms, some of which offer billing as a sideline to their medical billing software business National firms with local branches 7

8 Types of Medical Billing Services Kitchen Table Billers Kitchen table billers are the solo billers who have worked in a medical office and then decide to start their own company. Many larger companies started this way, and many of these billers are extremely capable. The issues to consider with these small companies include: Capacity will they be able to effectively handle your billing as your practice grows, or as they add additional clients? Key man dependence what happens to your billing (and your revenue) if something happens to your solo biller? Is there any back-up? Personal service solo billers often provide excellent customer service, to the extent of their knowledge and capabilities Reporting will your solo biller have the knowledge and expertise to provide the types of reports you need to manage your practice revenue? Specialty knowledge if a solo biller started billing in one specialty, he/she may not have the knowledge to handle other specialties. Technology will your solo biller be able to provide the best medical billing software available, and have the skills to maximize its value for your practice? 8

9 Types of Medical Billing Services Medium-Sized Firms Medium-sized firms are those medical billing services that have grown beyond the kitchen table size and are now handling multiple clients. The companies have generally hired some additional employees and invested in some technology. The issues to consider with these organizations include: Growing pains as an organization grows, there may be growing pains that can affect your results and their customer service. Ask about strategic planning, financial resources, staffing plans, etc., to insure that the organization will be able to support your practice through their growth and yours. Key man dependence even though the organization may have grown, you want to make sure that the infrastructure is in place to assure continuity if something happens to the founder/key manager. Specialty knowledge once again, if a biller started in one specialty, he/she may not have the knowledge to handle other specialties. However, the pressure to maintain growth may compel him/her to take on specialties the organization is not prepared to handle. Customer service Often these companies provide excellent customer service, especially to those practices they ve served since the beginning. However, if the billing company is challenged to keep up with its own growth, customer service may suffer. A key question: Will you have a dedicated Account Manager? Technology ask detailed questions about the technology used by the organization. Be sure they re using the latest software and that they keep it up to date. Image courtesy of Ambro / FreeDigitalPhotos.net. 9

10 Types of Medical Billing Services National Firms National firms are the large organizations that serve practices nationwide, often from one central office. Examples of these include both stand-alone medical billing companies and software companies that offer medical billing as a sideline. Some considerations for these options include: Customer service will you receive the customer service that you deserve? It s sad but true that when a company reaches a certain size, customer service often suffers. Ask if you will have a dedicated Account Manager, and what services they will offer your practice. Follow-up it was reported at the 2011 American Medical Billing Association (AMBA) meeting that at least one large organization was offering a low percentage rate to handle billing, but neglected to mention that this didn t include any follow-up. Understand what services you will receive and how aggressively the organization will pursue your reimbursement. Technology will you have options in terms of the software used? If your biller also sells software, this is unlikely. Make sure you re getting technology that serves your purposes and not just the biller s. 10

11 Types of Medical Billing Services National Firms With Local Branches A new model of medical billing service has emerged to offer both the resources of a large organization and the customer service provided by a smaller one. National firms with local branches over the last few years, a new model has emerged to offer both the resources of a large organization and the customer service provided by a smaller one. This includes medical billing companies that have joined together as a network to offer nationwide coverage with local branches. These branches are run by experienced managers who have been in the field for years and understand the issues. At the same time, they can draw on the resources of other companies in the network to insure timely filing, thorough follow-up and back-up in case of natural disasters. Areas to consider with these groups include: Customer service these types of groups should provide a high level of customer service. You should be assigned a dedicated Account Manager who understands your specialty and is able to work with you on improving your practice profitability. Staffing depth because these types of firms provide multiple local branches, they are well protected in cases of natural disasters or workflow overage; they can simply shift the work to another branch. Technology again, ask if you will have options in terms of the software used. A national firm should offer you a well-researched, trusted software solution and training. 11

12 Types of Medical Billing Services Specialty knowledge a national firm offers a broad range of specialty knowledge because of the variety of practices they handle. And one benefit of a national firm with local branches is that they can share expertise across their multiple branches, giving you the specialty knowledge of hundreds of billers and managers. Reporting this type of national firm should offer good, indepth reporting for your practice, not just on your monthly billing, but on trends for your KPIs. Be sure to ask to see samples of the reports provided. To determine which of these categories a medical billing service belongs in, gather this information on your candidates: How many years in the industry Number of employees and organizational chart Gross amount of billings Number of clients by specialty Number of claims processed annually This will give you a feel for the size of the organization, the phase of development the organization is in, how well developed the organizational structure is (and if there is any structure) and the types of specialties the organization handles. 12

13 Types of Medical Billing Services 1 Beware the Warning Signs Be wary of these warning signs when assessing an organization: Company has been in business for more than 3 years without significant growth Company is represented as being sizable, but no organization chart or reporting structure is available Company operates out of a home, executive suite (transitory) or another business Company handles only one specialty, and it s not yours Number of claims processed annually is less than the number of claims processed by your practice, or has not increased from one year to the next Image courtesy of 89studio / FreeDigitalPhotos.net. 13

14 If a medical billing company can t keep your denials, DRO, net collection rate and other key performance indicators (KPI) within industry standards, then other issues such as customer service are moot. How to Evaluate a Medical Billing Service Key Criteria When you decide to consider an external medical billing service, there are several criteria you should evaluate: Performance Customer Service Compliance Reporting/Transparency Technology Capability/Scalability Pricing Let s look at each of these areas and key points you need to evaluate within each. Image courtesy of magerymajestic / FreeDigitalPhotos.net. 14

15 How to Evaluate a Medical Billing Service Key Criteria Performance One of the first areas to consider, of course, is performance. If a medical billing company can t keep your denials, DRO, net collection rate and other key performance indicators (KPI) within industry standards, then other issues such as customer service are moot. Key Performance Indicators To get a feel for how well the medical billing service candidate performs within common KPIs, ask: 1. What is your clients average Days in Receivables Outstanding (DRO)? 2. What is your clients average A/R over 120 days percentage? 3. What is your clients net collection rate? 4. Has your clients cash flow improved or declined over the last 90 days? If it has declined, why? Also ask: What resources does the group dedicate to the last 20-30% of claims that are harder to collect and often never paid? Image courtesy of basketman / FreeDigitalPhotos.net. What is the service s process for continuous improvement? Do they evaluate their performance every month and assess where improvement is needed? You want to find a group that is striving to be better and will help to make your practice better. 15

16 How to Evaluate a Medical Billing Service Key Criteria Timeliness Ask if adequate checks and balances are provided between the practices and the medical billing service to assure that all charges or superbills are being entered in a timely fashion. A typical benchmark for this would be a guaranteed entry rate of 48 hours. Does the service have a good audit system to confirm charge entry against a service/procedure log to avoid missed charges? References Can the medical billing service provide you with references in your specialty? If you talk to the key contact, be sure to ask the performance questions above to validate the information you are receiving from the service. Ask if they are offered any compensation for acting as a reference, and if so, what is it? A small gift is normal, but anything extravagant raises questions about the validity and enthusiasm of the reference. Pay attention to the service s responsiveness while you are interviewing them. If they are not as responsive as you would like during the dating phase, they are not likely to become more responsive after you re married to their service. 16

17 How to Evaluate a Medical Billing Service Key Criteria Customer Service Customer service is very important in revenue cycle management, both with patients who may be calling about bills, and with physicians who must know how the practice is performing, whether only for their own peace of mind or to report to a managing committee. What level of customer service will the medical billing service guarantee? Do they guarantee a response to questions within a specific time frame? Does the service provide an Account Manager? If so, what level are they and what authority do they have? How many clients will they be handling? Inevitably, even with the best medical billing service, problems will occur. What is the service s process for reporting and escalating problems? If there is no established process for handling problems, this is not a good sign; it doesn t mean that there are no problems but just that the service doesn t have a good process for dealing with them. Pay attention to the service s responsiveness while you are interviewing them. If they are not as responsive as you would like during the dating phase, they are not likely to become more responsive after you re married to their service. Image courtesy of stockimages / FreeDigitalPhotos.net. 17

18 How to Evaluate a Medical Billing Service Key Criteria Be sure to check with the medical billing service candidate to make sure they have procedures in place to prevent the hiring or retention of excluded employees. Compliance A key area to check with a medical billing service candidate is compliance. If the service is not in compliance with current regulations, your practice can pay the price. Laxity in this area is a serious warning signal make sure your potential partner takes this seriously. Here are some key areas to ask about: HIPAA Is the service up to date on HIPAA requirements and do they provide training to employees? What technology do they utilize to insure there are no data breaches? Lost laptops are among the most common causes of data breaches; do they have a system to insure data, whether on laptops, media or desktop computers, is not lost or stolen? Exclusion Exclusion is when the U.S. Office of the Inspector General (OIG) prevents an individual or entity from participating in Medicare, Medicaid, or other federal health care programs, generally as the result of conviction of a crime or other program noncompliance. The practical result of exclusion is that no program payments will be made for items or services furnished, ordered, or prescribed by an excluded entity or individual. It s important to note that this includes your medical billing service whether you knew about the exclusion or not. Be sure to check with the medical billing service candidate to make sure they have procedures in place to prevent the hiring or retention of excluded employees. 18

19 How to Evaluate a Medical Billing Service Key Criteria ICD-10 The conversion to ICD-10 coding will affect every part of your practice, and could stop your cash flow for months if not handled correctly. That s why it s vital that you select a medical billing service that will be ready for the new code set. Ask the services you are interviewing what their plan is for converting to ICD-10. Do they have a plan in place? Have they started getting training on the new code set? Do they have any plans to help their clients with the transition? How did the conversion to 5010 go for their business? Weigh the answers from your candidates and watch for the service that has evaluated the impact to their business and has a plan in place to train, test and implement ICD-10 in time for the Oct. 1, 2014 deadline. Reporting /Transparency It s vital that you get regular, clear reports on your medical billing and practice revenue. A common complaint from providers is that they aren t getting the reports they need from their medical billing services or internal billing staff. You certainly must understand how important it is to have transparency into your revenue, costs and receivables in order to manage your practice. If not, then recent reports about practices going bankrupt should clarify the importance of good financial management. In the article, 17% of all doctors with a private practice said they could foresee closing it within a year if their financial situation doesn t improve. Don t let this happen to your practice. 19

20 How to Evaluate a Medical Billing Service Key Criteria With the economy and healthcare environment in flux, healthcare providers absolutely must be on top of their financials. You can no longer assume that if you re busy seeing patients, you re making money. Why? Because of denials and reduced reimbursements. You can be busy with patients all day long, but if the claims are denied due to coding and timely filing errors, etc., you are working for free. And then there s the danger of embezzlement. Internal billing departments, sadly, are too often hotbeds of embezzlement because physicians are too trusting. Looking at financial reports on a regular basis and checking a few things here and there is one quick way to avoid embezzlement. Many embezzlers start simply because they know that no one is checking on them. Of course, the reason many internal billing departments don t provide these reports is lack of reporting knowledge. The billing staff may know how to code and file claims, but really don t understand how to compile a clear, accurate financial report. Image courtesy of Ddpavumba / FreeDigitalPhotos.net. Sadly, the same goes for some medical billing services they understand the coding and billing portion of the business, but reporting is not their strength. Needless to say, this is very dangerous to your practice. 20

21 How to Evaluate a Medical Billing Service Key Criteria You should have access to, and be checking on a regular basis (at least once a month, more often if financials are a concern) some key performance indicators for your practice. At a minimum, you need to see reports like these on a regular basis: Accounts Receivable aged by either date of entry or date of service Practice Analysis overall reporting of the practice charges and receivables Transaction Report general report of payments, charges and adjustments Claims Report to show claims submitted for a reporting period Managed Care reports to show loss of revenue, adjustments, timely payment and referral tracking Your selected vendor should also work with you to develop reports that benchmark your practice against historic data and recognized national benchmarking indices, such as Medical Group Management Association (MGMA) productivity benchmarks. As discussed earlier, the ideal vendor should also help you analyze your data and give you feedback about its meaning. This data, once analyzed and broken down into usable information, becomes a valuable tool for you to use when negotiating with payers, assessing the financial performance of the practice and conducting vital strategic planning and analysis. Image courtesy of PANPOTE / FreeDigitalPhotos.net. 21

22 How to Evaluate a Medical Billing Service Key Criteria Technology An additional benefit of using a larger, national billing firm is that you will often receive medical billing software, practice management software, scheduling software or an EMR free as part of your contract. Getting this technology for your practice without a big investment on your part is a big plus. Just make sure that you ask questions such as: Is the technology solution up to date? An older solution, or one that hasn t been updated, may not provide you with the tools you need to manage your practice Does the vendor have good backup/security systems in place? As mentioned above, HIPAA considerations as well as the need to keep financial information secure require that your vendor have good systems in place. Is the technology solution cloud- or server-based? Consider what will work best for your practice. Cloud-based solutions offer the convenience of logging in from nearly any location and software that is instantly updated; server-based software may provide some features not available elsewhere. Evaluate the benefits and requirements for your practice. Does the medical billing service offer an EMR? If so, this could be a significant benefit, if it allows your practice to qualify for HITECH incentives. Ask what the service provides, and determine whether it meets your practice s needs. Image courtesy of nokhoog_buchachon / FreeDigitalPhotos.net. Your practice will need to live with this technology day in and day out, so be sure you feel it will meet your practice and reporting needs 22

23 How to Evaluate a Medical Billing Service Key Criteria Capability/Scalability Naturally, a key to selecting the right medical billing service is evaluating both the service s capability, or qualifications, and its scalability. You want to make sure that the service is qualified to handle the type of billing you need, and that it has the capacity to handle your billing in a timely fashion. Certification/Training You can ask for references from the medical billing service, and should, but another good way to assess the qualifications of the management and staff is to ask about certifications and ongoing training. There are two organizations that certify medical billing personnel: The Healthcare Billing and Management Association and the American Medical Billing Association. Ask your medical billing service candidates how many of their personnel hold one of these certifications. Also, ask whether the service invests in continuing education for its staff members. It s important for billers to stay up to date on changing requirements in the industry, and the organization should encourage this. Image courtesy of photostock / FreeDigitalPhotos.net. 23

24 How to Evaluate a Medical Billing Service Key Criteria Scalability/Capacity As mentioned earlier, there are varying sizes of medical billing services, as in any industry. While we all want to encourage new business growth, it s important to insure that the billing service you sign on with has the capacity to accommodate your billing needs in a timely fashion. If the vendor is small or will need to add staff, you need to assess their ability to scale quickly and effectively. Ask for information regarding: What is the current size of the organization? If they are adding staff to handle your billing, what percentage growth will this be? Growth of more than 10-20% could mean untrained staff and lack of oversight. Will the service use its own staff with oversight, or subcontractors? Will the service outsource overseas? If so, has it done this before and is familiar with language, culture and training barriers? How many practices is the firm billing for currently? Has this number grown, stayed the same or shrunk over the last year? What specialties does it currently handle? Do they handle your specialty, and can they provide references? You want your medical billing service to be effective in terms of collecting, but sensitive enough to not alienate patients. 24

25 How to Evaluate a Medical Billing Service Key Criteria Patient Collections Another key factor in evaluating the performance of a medical billing service is how effectively the service handles patient collections. Your medical billing service should have the same philosophy of and approach to patient service as your practice, since they are representing you. Also, you will want to ask what their process is for handling and communicating to you information regarding patient complaints about the collections process. Make sure that the service has a process for this, as you don t want to watch your patient base dwindle due to collections problems you didn t know about and can t address. Pricing A key concern for many practices when considering whether to outsource their medical billing is price. While you definitely want to investigate price, the key factor to consider, as with most things, is the return on investment. You may be concerned that one medical billing service is charging 8 percent of collections when another is charging 6 percent. However, if the first service is able to increase your bottom line by 15 percent and the second service only maintains the status quo, you are ahead by 7 percent (or 13 percent if you consider the 6 percent fee for maintaining the status quo to be a loss). Also, remember that a 10% improvement in quality means 10 times more to your bottom line than a 1% reduction in price. 25

26 That said, here are some considerations for the most common pricing models: Pricing Model How It Works Advantages Disadvantages Percentage You will be charged a percentage of collections, or a percentage of gross claims submitted or total collections. The success of the billing company is tied to the success of your practice. Due to a lower return on investment, your small claims may not be pursued as aggressively as larger claims. Fee With this model, you will be charged a fixed dollar amount per claim submitted. Potentially more cost effective. Provides less incentive for your billing service to follow-up on denied claims. Hybrid In this model, you will be charged on a percentage basis for certain carriers or balances and a flat fee for others Potentially more cost effective, if negotiated correctly. Provides less incentive for your service to follow-up on certain claims that provide a lower return. Consider the advantages and disadvantages of the different models for your specialty and practice, based on the types of claims you usually encounter. Also consider how well your current model works for your practice, and adjust accordingly 26

27 s: What Do You Get for Your Percentage? When considering a medical billing service, many providers wonder, why should I pay a percentage of my hardearned revenue to a service? As with most things, what s important is not what you re paying, but what you re getting in return. So let s take a look at what you get for your percentage payment when you work with a medical billing service: Staff redundancy with a medical billing service, you have assurance that if one person is out, your billing won t come to a screeching halt. Medical billing services of any size (not including kitchen table billers) provide redundant staffing, so that your billing continues uninterrupted and with consistent expertise regardless of personnel issues. Knowledge because it s their business, a medical billing service must stay up to date on the latest payer requirements, denial prevention techniques and effective appeals strategies. In-house billing staff are not usually able to maintain this type of up-to-the-minute knowledge because of the day-to-day demands of working in a practice. Persistence a good medical billing service will be able to get your practice paid more than the typical in-house billing staff, because of the knowledge, techniques and doggedness they apply to the difficult claims. How often does your in-house staff write off claims that could be paid with a little more effort? Currency with latest regulations and payer requirements again, because it s their business, a medical billing service must stay up to date with the latest regulations such as HIPAA, ICD-10, E/M coding issues, etc. They also work with multiple payers and know their requirements and what works in terms of appeals. This is information that most in-house medical billing staff do not have the time or resources to keep up with. 27

28 What does internal billing really cost you? Many practices assume that in-house medical billing is the less expensive option. However, it s important to look closely at what the true costs are. In addition to the opportunity costs in terms of potential lost revenue from denied claims, failed appeals, etc., the cost of maintaining an internal staff is often much higher than most providers believe. With internal medical billing, salary is typically only about 70-75% of your employee costs when you figure in payroll taxes, FICA and insurance, the costs add up quickly. Costs to include in your calculations are: Medical Billing Specialist s Employee salary Medical Billing Specialist s Employee benefits Worker s compensation FICA Healthcare insurance $ $ $ Vacation, sick leave, etc. Performance bonus Computer hardware purchase & maintenance Software purchase & renewal Many practices assume that in-house medical billing is the less expensive option. However, it s important to look closely at what the true costs are. 28

29 Plus, consider the added paperwork cost of administering the employees. And when your medical billing specialists are sick or on vacation, you re still paying them for not working. When you outsource your billing and take advantage of our professional medical billing specialists, the overhead and paperwork is ours, not yours. And don t forget, when your billing is handled internally, if you lose a core member of your team you can lose years of training and knowledge. With a reasonably-sized medical billing service, you are guaranteed complete redundancy so that there is continuity of business processes which is a significant burden off your shoulders. Finally, don t forget the importance of insuring that none of your medical billing staff has been excluded by CMS. If you are employing excluded staff, you could lose your right to bill Medicare and that could be disastrous. A medical billing service protects you from this risk, insuring that all of their staff is legally able to handle Medicare claims. Again, they must do this because it means their business if they don t.? Conclusion: Make the Choice that s Right for Your Practice In the end, when choosing a medical billing service it s important to make the choice that s right for your practice. Outsourcing this part of operations to an outside vendor should allow for 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 associated with billing and collections. By doing this, your practice can take advantage of all the functions associated with the front-end, but leave the tedious and time-consuming claims processing, payment posting, appeals, denial work and account-receivable tracking process to the third-party vendor. 29

30 Resources Checklist of Questions for Potential s (Note: some questions should be asked directly, others based on observation) Background How many years has your company been in the industry? How many years experience does management have in the industry? Number of employees and organizational chart? Gross amount of billings? Number of clients by specialty? Number of claims processed annually? Can you provide a list of current and past client references? Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net. Performance What is your clients average Days in Receivables Outstanding (DRO)? What is your clients average A/R over 120 days percentage? What is your clients average net collection rate? Has your clients cash flow improved or declined over the last 90 days? If it has declined, why? What resources does your company dedicate to the last 20-30% of claims that are harder to collect and often never paid? What is your process for continuous improvement? Do you evaluate your performance every month and assess where improvement is needed? 30

31 Resources X Image courtesy of basketman / FreeDigitalPhotos.net. Customer Service Does your company provide an Account Manager? If so, what level are they and what authority do they have? How many clients will they be handling? How does communication between the practice and the billing service occur? What is your process for reporting and escalating problems? What options are offered for claims submission? Is there a separate form for patient and charge entry, EOB posting, and online claim editing? Are any of the claim validity tests available during data entry? Do you have a customer-service process or guidelines you can share? Do you monitor actual payments versus our contract to insure that we are paid the contracted amount? Does the medical billing service present itself as a vendor or as a strategic partner to the practice? (Observation) Compliance Do you have a HIPAA-compliant record retention and storage policy? Do you provide HIPAA training to employees? What technology do you utilize to insure there are no data breaches? Do you have procedures in place to prevent the hiring or retention of excluded employees? Do you have a plan in place for ICD-10 implementation? Have you started getting training on the new ICD-10 code set? Do you have any plans to help your clients with the transition to ICD-10? How did the conversion to 5010 go for your business? Do you have a disaster-recovery policy? 31

32 Resources Make sure the service is qualified to handle the type of billing you need, and that it has the capacity to handle your billing in a timely fashion. Technology What information system do you use? Is the technology solution up to date? What backup/security systems do you have in place? Is your technology solution cloud- or server-based? Do you offer an EMR? Is the technology customizable? Can we adapt and develop reports that are unique to our practice or specialty? Would you be willing to demonstrate the billing and collections system? Capability/Scalability Are your employees certified or credentialed? If so, how many and what are their certifications? Do you conduct background checks on new and current employees? How do you measure employee productivity? Do you have ongoing training for your employees? Do you perform quality-assurance reviews of your employees work? Will you be hiring additional employees to handle our billing? If so, what percentage of your current staff will this be? How many office locations do you have currently, and is there capacity in these offices for additional staff if needed? Will you use your own staff with oversight, or subcontractors? Will you outsource overseas? If so, have you done this before successfully? 32

33 Resources Image courtesy of adamr / FreeDigitalPhotos.net. Reporting/Transparency Do you provide management reports on a monthly basis? What are they? Can you produce individualized, unique reports? Can you provide reports like these on a regular basis: Accounts Receivable aged by either date of entry or date of service Practice Analysis overall reporting of the practice charges and receivables Transaction Report general report of payments, charges and adjustments Claims Report to show claims submitted for a reporting period Managed Care reports to show loss of revenue, adjustments, timely payment and referral tracking Can any of these reports be generated from your software by the practice as needed? Do you follow standard industry-recognized benchmark performance criteria? Pricing How do you charge for your services? Percent of gross collections? Fee per claim? Other? How do you avoid the disadvantages associated with your model, such as less incentive to pursue small claims when you re charging a percentage? Are there costs associated with startup? Adding new providers? 33

34 Resources CHECK REFERENCES! Good? Average? Poor? Procedures Is there a policy and procedure in place for bad debt or small balance write-offs? How are bad-debt collections handled? Is there a conversion process and schedule? How are accounts receivable from a previous billing company or in-house billing process handled? Who has ownership of the data if the contract is terminated? Reference Questions Checklist Ask the medical billing service for 2-3 references for whom they have billed for more than 6 months and within the last year. When you contact the references, ask how these areas performed with this medical billing service: Did your average Days in Receivables Outstanding improve? Did your average A/R over 120 days percentage improve? Did you see an improvement in your net collection rate? Did your cash flow improve or decline with this billing service? How would you rate the customer service? How would you rate the reporting? Have you felt informed about your practice s performance? 34

35 Entrust Your Medical Billing to the Experts Your revenue cycle management is too important to your practice to entrust it to people without the time and experience to execute it correctly. Are you confident that your billing staff or small medical billing service are able to handle the complexities of today s medical billing, particularly with ICD-10 around the corner? If your denials are increasing, or your Days in Receivables Outstanding KPI is rising, the chances are not good. That s why now is the time to consider moving your medical billing to a nationwide medical billing company with the resources to handle the transition and yet still provide local service. With over 50 years of combined management experience and multiple branches around the U.S., Medical-Billing.com is proud to deliver excellent results for our physician partners through a relentless focus on efficiency, technology, training and measurement of metrics. On average, our physician clients get paid faster than 75% of multi-specialty group practices nationwide as surveyed by the Medical Group Management Association and Healthcare Billing Management Association for Days Revenue in AR. To show you how you could benefit from Medical-Billing.com s higher level of service, we d like to offer you a free analysis of how we could improve your cash flow. Contact Medical-Billing.com today at Or us: sales@medical-billing.com 35