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Five Key Questions to Ask a Medical Billing Service

It takes a leap of faith to outsource the billing function. Few decisions carry such direct implications for a practices bottom line. Given the delicacy and importance of the billing role, its important to find a trusted provider. The following top five considerations help medical practitioners cut through the hype and identify a reliable, long-term medical billing partner.

Medical billing services boast stunning results--but can they deliver? Some can. To identify real expertise from marketing hype, medical practitioners need to dig deeper than performance track record metrics. The following criteria can help vet third-party medical billing candidates:

1. Employee Resources

The number and expertise of employees assigned to the account is the best predictor of success. Healthcare consultant Janet Marcus advises practitioners to find out the following information about the billing services human resources commitment:

  • How many employees will support the account?
  • How many years experience do they have?
  • Are they experienced in the practices specialty? Many agents are trained to collect a specific type of claim, such as radiology, radiation treatment, chiropractic care, and vision care.
  • Are the billing services employees credentialed?

2. Regulatory Compliance

The responsibility for legal compliance resides with the medical practitioner, whether or not they outsource collections to a medical billing service. Practice management journal Physicians Practice sounds a note of caution: "Billing services have been known to change codes to boost collections. Remember that if you do outsource billing, you are still responsible for regulatory compliance."

To vet a service providers trustworthiness, ask to see the list of compliance policies and procedures their staff uses. Marcus recommends asking the billing service to detail "how [it] informs staff of current state and federal rules, regulations, and guidelines" and whether the organization has ever experienced a claims review or compliance charge.

3. Customer Service Standards

When dealing directly with patients, the medical billing service is the face of the practice. Its important for the practitioner to make sure customer service standards comport with the image the practice is trying to maintain. A well-run billing service will have customer service guidelines for staff to follow when dealing with the public--practitioners should ask to review them.

4. Performance and Accountability Metrics

Ceding responsibility for billing to a third party calls for comprehensive performance metrics. Janet Marcus recommends asking the billing service to detail its standard performance benchmarks. Does the organization conduct quality reviews of employee performance? How does the service measure employee productivity?

Make sure the billing service maintains its accountability by presenting regular updates on performance and progress. Monthly reports are standard practice; review a sample monthly report to ensure detailed and meaningful metrics.

5. Information Technology and Resources

As medical billing moves to electronic claims submission, its becoming increasingly important to have technology solutions in place. What IT resources does the medical billing service have in place? If the service does employ an automated system, investigate how frequently it updates the system to stay up-to-date with required industry changes.

The right medical billing service can boost collections and save a practice the administrative headache of submitting claims. To find the right service provider, its important to perform a comprehensive background check. Let these solid vetting criteria cut through the hype and identify a skilled and reliable billing partner.


Medical Group Management Association

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