Your Practice's Missing Piece

How To Choose a New Hampshire Medical Billing Company

Graphic of medical billing company questions

In today’s complex and competitive world of healthcare, the financial fitness of a medical practice hinges on efficient and effective coding, billing, and follow-through of claims. Constant regulation updates and new policies, such as the transition to more complex ICD-10 coding, make it imperative that billing teams keep up – or risk losing money, insurance partnerships, and reputation.

Given the high stakes involved, it’s no wonder that many practices have already outsourced their billing. On a global scale, outsourcing is on the rise, notes Kelly Goochon in her article about Medical Billing Outsourcing in Becker's Hospital Review. She notes that healthcare organizations are resorting to outsourcing a number of their practices, including billing, and that the global billing outsourcing market is expected to report a high single digit growth rate over the period of 2016-2023. (1)

Source (1): Article by Kelly Goochon

As a medical billing and coding consultant, I’ve worked behind-the-scenes with medical practice owners, administrators, and billing professionals in New Hampshire and across the U.S., helping to streamline their practices and enhance their profitability. Since people often ask me, “What questions should I ask before outsourcing my billing?” I’ve compiled this list to serve as your guide for interviewing any firm who aspires to perform this vital function for you.

10 Questions to Ask Before Hiring a Medical Billing Company For your New Hampshire Practice

1.) Are all billing employees located on-site at a U.S.-based office?
The answer to this important question can give you a glimpse into the billing firm’s corporate culture. It can also indicate how your potential new outsourced-staff is managed, and how your account will be handled.

Firms with on-site team members tend to have a culture of stronger internal communication, camaraderie, and best-practice sharing through collaborative on-site training. On-site team members are also often more readily accessible than those who work off-site.

2.) Are medical claims handled in-house or by off-shore agencies?
It’s important to know where your claims will be handled, and by whom. For example, some billing firms may have a “home office” in the U.S., but they outsource claims-handling to agencies in other countries, such as India. Aside from the impersonal, non-partnership aspect of this approach, any further outsourcing by your billing firm creates vulnerability in the form of less control and accountability for your claims-billing and cash-flow.

3.) Where is the firm’s office located, and what are the support hours?
Regardless of the fast pace of business and healthcare today, classic considerations such as location and service hours remain vital to building a successful partnership with your medical billing provider. For example, if your medical practice is in California and you choose a firm in New York with support that ends at 5:00 p.m. east-coast time, your support ends at 2:00 p.m. west-coast time, posing a potential issue.

Partner with a firm that is available to you beyond the typical “9 to 5” business hours, such as from 7 a.m. – 6 p.m. Also, ask if they provide a phone number or email address that’s monitored outside of their office hours, should an urgent situation arise for you.

4.) What types of billing services and customer support are offered?
The most basic reason you need a team of competent billing specialists is to ensure your compliance with the myriad regulations governing your claims-filing and record-keeping. Compliance, however, is just a fraction of what it takes to ensure a profitable practice.

You deserve an expert billing and reimbursement partner that shares your goals, including: more time to see patients; revenue generation; consistent cash flow; regulation compliance; and overall peace of mind.

Other key aspects of support, and questions surrounding them, should include:

Call-handling:

  • Are calls personally answered, or is a machine or non-staff answering service used?
  • Is the firm’s staff trained to answer calls and follow through promptly and thoroughly?

Dedicated billing specialists:

  • Are accounts assigned a dedicated account manager?
    If so, does that person work in partnership with another specialist in support of your account?

Multi-lingual support:

  • Does the firm employ bilingual team members?
    Spanish is preferable, since it follows English as the second most popular language in the U.S.

5.) What type of reporting is offered, and how often?
The goal of any reporting tool is highlight progress and potential. A medical billing firm that is truly in partnership with you, strives to consistently communicate with you – at whatever level you desire – to keep you informed. Reporting and communication tools can range from regularly-scheduled calls with your account manager, to a quarterly “Report Card”, to an Annual Report that serves as your year-in-review for billing and reimbursements.

6.) What is the average claims collection rate?
Ask if the firm sets a goal (and shares it with clients) for their rate of claims collection. This will quickly tell you how serious they are about potential partnership with you. For example, my firm’s goal is clearly stated as, “Keep 90% of claims under 90 days old”. Reimbursement is the life-blood of your cash-flow, so it pays to partner with a firm that can proudly profess its goals and performance with claims collection.

7.) Is audit support offered?
Ask if the firm offers audit support, and what is specifically included in their support package. Every practice is always under auditor-scrutiny, so it’s important to know what type of audit support is offered for when – not if – your practice is audited. Healthcare today is under tight scrutiny with Medicare auditors. Auditors review the claims that have been sent to them, and ask for supporting documentation to ensure that all Medicare policies are being met, to the letter of the law.

Medicare audits require a skilled professional that:

  • Knows the policies of Medicare
  • Can gather all the appropriate documentation
  • Can write an effective letter to support the claim
  • Performs consistent follow-through to advocate on behalf of their client

For example, for all claims that that my firm submits on behalf of clients, my team follows them through to completion – including the audit process. We follow a company-wide audit protocol, and we proudly measure our success. Our team’s success rate is 100% on Medicare audits that we have scrubbed in preparation for audit compliance. As an additional service, we offer compliance scrubbing, and enable clients to choose which claims are scrubbed for compliance auditing. Regardless of whether we pre-scrub a claim, we do not charge additionally for audit support on claims that we bill, and we stand behind each claim until our clients get paid.

8.) How are denied medical claims handled?
Since swift claims-reimbursement is the key to cash-flow, it’s vitally important to know how (and how quickly) your denied claims will be handled. The longer the time between denial and re-submission, the less your chances of reimbursement. Better yet, to avoid a claim denial altogether, the more proactive question should be, “What is your claims-scrubbing process?” When a claim is reviewed thoroughly, or “scrubbed” for coding or compliance errors before submission, it is much more likely to be paid – thus, avoiding the need to handle again after denial.

9.) What is the implementation process for medical billing systems?
There are typically two types of situations for hiring a billing partner:

General Situation: A general situation can be when you’re planning ahead for transition to outsourced billing if your in-house billing employee is retiring, or if you’re setting up a practice and seeking a billing partner.

Emergency Situation: An emergency situation can be when your in-house billing employee(s) suddenly leave, or when your current biller suddenly no longer supports you. This situation calls for your quick transition to a new billing specialist.

Either situation calls for similar questions of a potential partner billing firm, including:

What is your on-boarding process?
This process involves how – and how quickly – the firm can mobilize to transfer records, and whether they can dedicate a transition-specialist to your account.

Are there any initial implementation fees?
Some firms charge initial fees, and some do not. Be sure to get the particulars of their fees, so you know any costs before you consider hiring them. Since most billing companies charge a percentage of each claim collected – and claims are not typically paid before 30 days, some billing companies have a minimum per-month fee, or they have a flat-rate implementation fee that will cover the first 30 days.

10.) What software is used, and how is your patient database accessed?
The goal of using medical billing software is to streamline your medical coding and claims submission, using one comprehensive database and system of billing and record-keeping. Your billing partner’s staff should be well-trained and fluent in several billing software platforms. They should also have their own software available for use, for instances when a client doesn’t already use billing software. They should also discourage receiving claims via FAX from your medical office, in favor of more streamlined electronic tools.

Smart Selection of a New Hampshire Medical Billing Company Ensures Healthy Cash Flow for Your Medical Practice

In short, the smartest way to select the best billing partner for your practice starts with understanding how they can (and should) support you. Do your research, give each potential billing partner a thorough “checkup” by asking good questions, and you will be well on your way to leading a more efficient and profitable practice.

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About the Author:

A successful educator, trainer, and author, Erin Cammarata is sought by industry professionals and individual clients for her medical practice expertise, consultation and training services. As Founder and Principal of New Hampshire-based CBS Medical Billing and Consulting, LLC, Erin leverages more than 20 years of comprehensive practice management experience to help medical practices throughout New Hampshire and the U.S. to overcome the challenges that inhibit their profitability.