Clinics, hospitals, medical practices, and other organizations that provide medical services often outsource their medical billing. Rather than adding the costs of a medical billing department to their business expenses, they take advantage of efficiencies that can be realized by hiring a company that handles billing for multiple clients. Removing billing staff from their payroll helps healthcare providers focus on what they do best — delivering medical services to their patients.
Outsourcing avoids the headaches caused by employee turnover and the risk of hiring untrained staff. Staff shortages and slow learning curves can cause delays in billing and lead to cashflow problems. Outsourcing medical billing shifts responsibility for professional and timely bill preparation to a company that devotes all its resources to medical billing.
Some billing companies are better than others. When a medical practice decides to enter into a professional relationship with a medical billing company, how can it know that it made the right choice? Here are some important questions that will help a healthcare organization assess the quality of its medical billing company.
How Does the Company Protect Confidential Data?
Billing companies translate medical records into billings. The patient information in medical records is confidential. A billing company that is not HIPAA complaint places healthcare providers at risk.
While the company might access medical records online, it is important to know how the company protects passwords, emails, and downloaded data. Who has access to passwords and how are passwords stored?
If the company keeps protected health information on its own servers, the healthcare provider should understand the company’s policy regarding the destruction of that information. The provider should understand exactly how confidential data is overwritten so that it can’t be stolen by someone who gains unauthorized access.
How Easily Can You Access Information About Your Insurance Claims?
After medical billing companies prepare bills, they submit the bills to insurance companies, Medicare, or other sources of payment. Healthcare providers have a keen interest in tracking the status of those claims.
Medical practices increasingly use electronic medical records (EMR) or electronic health records (EHR) to keep track of patient data. Ideally, the software will sync with a medical billing system, allowing the practice to determine the status of billing and claims payments for each patient.
Some billers use their own software rather than the practice’s EHR or EMR software to prepare bills and submit claims. While there is nothing inherently wrong with wanting to use a single software system while preparing bills for multiple clients, healthcare providers may have difficulty accessing the status of their claims. A billing company might be hiding its lax approach to claims submission and collection by failing to make that information readily available to its clients.
How Timely and Useful Are the Biller’s Monthly Reports?
Ideally, a medical practice should be able to access its billings and determine insurance claim status in real time, either by running reports on its own software or by having access to the biller’s system. When that doesn’t happen, the biller should at least provide monthly reports each month that provide details of bills submitted, claims paid, and claims pending, with granular information about the failure of an insurer to pay each unpaid claim.
Even when the practice has access to that information in real time, monthly reports allow the practice to determine which areas of the practice are performing well and which are failing to meet established benchmarks. Monthly reports help medical practices fix problems and recalibrate expectations.
How Qualified Are the Company’s Staff Members?
Medical billing services should be staffed with billers and coders who have the education and training that allows them to do their work professionally. They should be fully trained to assign the correct Current Procedural Terminology (CPT) to procedures and services, accurate diagnostic (ICD) codes to a physician’s medical diagnosis, and Healthcare Common Procedure Coding System (HCPCS) codes to assure reimbursement by Medicare and Medicaid for supplies and procedures that aren’t covered by CPT codes.
Medical billers and coders need to have a basic understanding of anatomy, physiology, and medical procedures so that they can understand medical records and differentiate one procedure from another. They need to be trained to avoid upcoding and unbundling, two errors that will delay payment of claims and may lead to accusations of fraud.
Certified medical coders have completed a certification exam that requires them to demonstrate proficiency in CPT, HCPCS, and ICD codes. A company that focuses its hiring on certified medical coders or on coders with years of experience in the field is in the best position to deliver reliable results.
How Quickly Does the Company Respond to Concerns?
Patients, insurers, and Medicare auditors are among the persons who raise questions about medical bills. Those questions are usually directed to the medical practice that provided the billed services. Medical professionals need quick responses to those questions to satisfy patients, insurance companies, and the government.
A good billing company should have the resources to answer questions promptly. A company that responds “We’re busy right now, we’ll have to research the question and get back to you in a few days” puts a medical services provider at risk of losing credibility. An efficient and profitable medical practice depends on its billing company to provide fast answers to billing questions. Delays are a sign of a billing company that is trying to save money by hiring an inadequate number of qualified staff members. Delay could also signal errors that the billing company is trying to conceal.
Does the Billing Company Have a Denial Management Team?
Some claims are denied because the billing company made an error. When that happens, the company should be able to identify and correct the error immediately.
Other claims are denied because the insurer has an issue with the healthcare provider. The insurer might contend that billed procedures were unnecessary or that the provided procedures are not covered by insurance. A denial management team can work as an intermediary between the insurer and the medical practice to resolve concerns efficiently and productively.