Choosing a Billing Company: Key Considerations for Your Medical Practice
Are you struggling with choosing a billing company for your practice?
With so many options available, figuring out the best fit can be overwhelming.
Whether you’re a new practice owner or looking to switch providers, this decision is crucial for your financial health.
By the end of this post, you’ll clearly understand the essential questions to ask, the internal workflows to consider, and how to ensure your billing processes run smoothly.
Let’s dive in and make choosing a billing company a breeze, securing your practice’s revenue and efficiency for the long haul!
Key Takeaways
- Ask about handling incorrect insurance or subscriber IDs.
- Understand claims processing frequency.
- Ensure staff assignment consistency for better claim handling.
- Clarify the role of coding in billing.
- Check how the billing company handles rejections and denials.
- Know the patient interactions and collections process.
- Maintain internal management and oversight.
- Regularly review performance and adapt to changes.
Choosing the right billing company for your practice is crucial to maintaining a healthy revenue stream and ensuring smooth operations.
Let’s dive into what you need to know about selecting a billing company, the critical questions to ask, and how to integrate their workflows seamlessly into your practice.
Understanding Billing Companies: They’re Not All the Same
Billing companies differ significantly in the services they offer.
Healthcare billing might seem straightforward, but it involves many moving parts.
Operations’ front and back ends need attention to maintain a healthy revenue cycle.
From ensuring accurate patient registration to following up on claims, a lot needs to be managed.
Here’s what to consider when interviewing potential billing companies.
Key Questions to Ask Billing Companies
Correcting Insurance and Subscriber IDs
One crucial question is how they handle incorrect insurance or subscriber IDs.
If a patient’s registration is erroneous and a claim is rejected, will the billing company notify you to correct it at the patient level, or will they only fix it on the claim and resubmit it?
This distinction can impact whether the same issue recurs.
Claims Processing Frequency
Please find out how frequently they process claims.
Do they scrub and send out claims daily or just a few times a week?
Understanding their workflow can help you anticipate how quickly claims will be handled and resolved.
Staff Assignment and Continuity
Another important aspect is the staffing structure.
Are the same staff members assigned to your account consistently, or is it whoever is available?
Consistency can lead to better handling of your claims since familiar staff are more likely to understand the nuances of your practice.
The Role of Coding in Billing
In-House vs. External Coding
Do billing companies handle coding based on the provider’s notes, or do they have certified coders who input codes themselves?
While some companies have certified coders who can ensure accurate coding under their license, it’s often best if providers have a significant role in coding due to their firsthand knowledge of patient care.
Double-Checking Codes
Even if the billing company doesn’t handle coding, you’ll need someone in-house to ensure all necessary codes, including injections, tests, and x-rays, are added correctly.
This step is crucial to avoiding revenue loss and preventing incorrect billing that could trigger audits or issues with insurance companies.
What is Medical Billing and Coding?
Communication and Follow-Up
Handling Rejections and Denials
How does the billing company handle rejections and denials?
Will they fix issues and not inform you, or is a communication process in place?
Clear lines of communication are vital to staying on top of any problems and resolving them promptly.
Patient Interactions and Collections
Does the billing company handle patient calls regarding account questions and manage collections?
If so, what level of collections do they offer?
Do they send accounts to external collection agencies, and do you have a say in this process?
These details can affect your patient relationships and overall revenue management.
Internal Management and Oversight
Even with a billing company, you’ll likely need to hire one or two people in-house to act as liaisons.
These individuals should understand coding and billing well enough to oversee the billing company’s work, request reports, and perform quality control.
As a provider, your focus should be on patient care, so having knowledgeable staff to manage billing interactions is essential.
Long-Term Considerations
Choosing a billing company is a long-term decision.
Changing companies can disrupt your cash flow and present numerous challenges.
Ensure you’re comfortable with your choice and have thought through the workflows necessary for success.
Ensuring your revenue’s backbone is solid requires considering every angle and potential future issues.
With diligent preparation and the right questions, you can mitigate many risks and set your practice up for smoother financial operations.
Handling Claims and Insurance Follow-Up
Insurance Follow-Up Protocol
A critical question to ask is how the billing company handles insurance follow-ups.
How long do they wait after submitting claims before following up with the insurance company if they don’t receive a response?
This follow-up is crucial to ensure timely payments and to avoid cash flow issues.
Resubmitting Corrected Claims
Will the billing company resubmit corrected claims for you if the claims are denied?
Some companies might charge extra for this service.
Make sure to clarify this point to avoid unexpected expenses.
Also, determine their process for correcting and resubmitting claims to ensure that issues are resolved quickly and efficiently.
Communication and Transparency
Communication Channels
Effective communication is key when working with a billing company.
Ask how they will communicate issues to you.
Will they notify you immediately of any problems with claims, or do they have a regular reporting schedule?
Knowing their communication style can help you stay informed and address issues promptly.
Standing Orders for Common Issues
Discuss the possibility of establishing standing orders for common issues that arise in billing.
For example, if certain types of claims are frequently denied for the same reason, can the billing company automatically address these issues without needing your approval each time?
This approach can streamline operations and reduce delays.
Patient Billing and Collections
Handling Patient Billing Inquiries
Collections Process
How does the billing company handle patient billing inquiries?
Do they have a dedicated team, and how do they communicate with patients?
Ensuring patient billing questions are handled promptly and professionally can improve patient satisfaction and prevent misunderstandings.
If the billing company handles collections, understand their process thoroughly.
How often do they contact patients with outstanding balances?
Do they work with external collection agencies, and if so, at what point is a patient’s account sent to collections?
Additionally, confirm whether you can review accounts before they are sent to collections.
Balancing Compassion and Business: A Workflow for Patient Collections
Medical Records and Audits
Requesting Medical Records
In some cases, insurance companies may request medical records to justify the necessity of a procedure before they make a payment.
Find out if the billing company handles these requests and how they ensure that all necessary documentation is provided promptly.
This process is crucial to avoid payment delays.
Dealing with Audits
If your practice is audited, will the billing company assist with providing the necessary documentation and support?
Understanding their role in this scenario can help you prepare and ensure compliance with all regulations.
Integrating Billing Workflows
Internal Workflow Integration
Integrating a billing company’s workflows with your practice requires careful planning.
Ensure a clear process for handling all billing-related tasks, from patient registration to claims follow-up.
This integration is vital to avoid bottlenecks and ensure everyone knows their responsibilities.
Training and Support
You may need to provide additional training for your staff to work effectively with the billing company.
Ensure a support system is in place to address any issues during this transition.
Clear communication channels between your staff and the billing company are essential for smooth operations.
Long-Term Relationship and Continuous Improvement
Regular Performance Reviews
Establish regular performance reviews with your billing company to assess their effectiveness and address any issues.
These reviews can help you ensure that the billing company meets your expectations and resolves any problems quickly.
Adapting to Changes
The healthcare landscape constantly changes, and your billing processes must adapt accordingly.
Ensure your billing company is proactive in staying up-to-date with the latest regulations and industry best practices.
This adaptability is crucial for long-term success.
FAQ: Choosing a Billing Company
What Should I Look for When Choosing a Billing Company?
When choosing a billing company, look for clear communication, prompt claim processing, accurate coding, and a strong follow-up system.
Ensure they handle patient calls and collections and provide transparent reports.
Ask about their staff, claim correction processes, and coding practices to ensure they meet your needs.
How Often Should a Billing Company Process Claims?
A good billing company should process claims daily to ensure timely submissions and quick resolution of any issues.
Consistent daily processing helps maintain a steady cash flow and reduces the chances of claim denials or delays.
Do Billing Companies Handle Coding For Claims?
Some billing companies offer coding services, such as reviewing provider notes and adding necessary codes.
However, ensure they have certified coders and communicate with your providers.
You might still need an in-house coder to double-check and prevent errors or missed charges.
What Questions Should I Ask Potential Billing Companies?
Ask about their claim processing frequency, how they handle incorrect insurance details, their follow-up system, and communication methods.
Inquire about their coding practices, patient call handling, collections process, and the number of staff assigned to your account.
How Can I Ensure a Billing Company is Doing Their Job Well?
Maintain regular communication, review their reports, and have an internal staff member double-check their work.
Stay involved in the billing process, understand their workflow, and ensure they meet your practice’s needs.
Regular quality control helps ensure they’re performing as expected.
Should I Handle Any Billing Tasks In-House?
Yes, even with a billing company, you should handle some tasks in-house.
Hire staff to manage coding, quality control, and direct communication with the billing company.
This ensures accuracy, prevents missed charges, and informs you about your practice’s financial health.
How Do Billing Companies Handle Patient Calls and Collections?
Billing companies often manage patient calls regarding account questions and handle collections.
Ask how frequently they contact patients, what their process is for overdue accounts, and whether they use external collection agencies.
Ensure you have a say in the collections process and review accounts before they go to collections.
What Should I Do if an Insurance Claim is Rejected?
Inquire about the billing company’s process for rejected claims.
They should resubmit corrected claims promptly and communicate any issues to you.
Understand their follow-up system and ensure they provide clear reports on rejections and resolutions.
How Do Billing Companies Manage Refunds and TakeBacks?
Billing companies should handle refunds and insurance take-backs efficiently.
They need to notify you of any required patient refunds or insurance take-backs.
Ensure they provide accurate reports and communicate any financial adjustments to keep your accounts balanced.
Is it Difficult to Switch Billing Companies?
Switching billing companies can be cumbersome and disrupt cash flow if not done properly.
Choose a company you’re comfortable with for the long term.
If you need to switch, plan carefully, ensure a smooth transition, and maintain open communication to avoid financial hiccups.
Final Thoughts
Choosing a billing company is a crucial decision that can significantly impact your practice’s financial health.
Asking the right questions, understanding the necessary internal workflows, and maintaining open communication with your billing provider can ensure your revenue cycle runs smoothly.
Remember, it’s essential to stay involved and perform regular quality checks to prevent issues before they become costly problems.
By reading this blog post, you’ve gained a comprehensive guide to navigating the complexities of selecting the best billing company for your practice.
You now have the tools to make an informed decision, ensuring your practice’s financial backbone remains strong and reliable.
Here’s to making the best choice and securing the financial health of your practice for the long term!