How to Choose the Right
Medical Billing Company

With so many options out there, finding who you want to work with, and what type of contract or relationship you want to pursue, is the most complex part of the outsourcing process.

What to look for when choosing a medical billing company

There are a number of things to look for when you choose a medical billing company. Obviously you want a company that is professional, timely, and has a good track record. Here we’ll go over just a few other things to look for.

Appropriate scale for your practice

This can determine if a medical billing company will be able to handle the needs of your practice.

Consider the volume of samples and claims that your practice deals with, and make sure that you find a practice that has the manpower to handle it. If your practice is especially large, then even an extremely good billing company may not be cut out to handle the work.

To this end, it is useful to ask about their current claims processing numbers, their collections percentages and amounts, the number of employees that they have, any automation procedures that they utilize, and any regular or expected training periods that they experience. The main thing you want to use for comparison purposes is the number of outgoing claims per unit of time that your practice is currently dealing with, so you can make any relevant comparisons. Although their office may be significantly larger or smaller than your own when it comes to employees, in the end it is their claims processing speed and collections percentages that matter.

Experience in your specialty

You want medical billing experts with an expertise in your specialty to ensure correct billing.

Medical billing varies widely depending on which medical specialty one is billing for. Plenty of excellent billing companies will simply not have anyone on hand who can bill for the specialties that you work in. Make sure to ask specific questions about specialties and sub-specialties that they have experience with, how many people on their staff are trained in the specialty you require, as well as any specific questions that you need to make sure that you trust that they know what they’re doing.

If you are an OBGYN, make sure that the billing company you intend to use also has staff trained in obstetric billing. If you are a Neurologist or Cardiologist, make sure that they are equipped to bill contemporary and emerging scan technologies, so that as these become more mainstream, your revenue diminish. If you know about any specific new technologies that you are implementing at your clinic, like extracorporeal membrane oxygenation machines or if your clinic performs normal but less common scans like DEXA, make sure to let your billers know in advance.

Cost breakdown in advance

Cost breakdowns can offer a clear comparison and make sure you are getting the best deal.

Although outsourcing your billing is almost guaranteed to increase your profits, you should ask who you’re working with for an explicit cost breakdown in advance. Billing companies will either charge by percentage, a flat fee, or some combination. Given this information, take your current patient load and try to get a rough estimate so you can know what to expect. Ask them for their current collections percentage (which likely differs from yours) as well as any additional fees or special service fees you’ll have to pay for reporting and other informational services, and you should be able to get a very informed estimate of your projected income. This is extremely useful when comparing your options.

Compatibility with your existing software

Transitioning to a new software can slow down operations. Ensure there is compatibility with current software or a clear onboarding process.

Most likely, you’re using some billing software to keep track of your accounts receivable, post payments to your system, and manage your laboratory data. Depending on what kind of reports you create internally and exactly what you use your system for, compatibility issues can end up requiring a lot of time and money to manage. In many cases, you can expect there to be someone who can walk you through any software changes you’ll be making. Doing this in advance can save you plenty of headaches down the line.

Make sure to ask about whether or not the outsourcing service will provide training to your employees. It’s also useful to understand how much access you will have to the billing data and processes, and how much time this data will take to reach you if it isn’t available in real time. If your team routinely interfaces with data in the billing process, whether it’s for reporting purposes or laboratory/clinical information, your workflow will be seriously interrupted if this information now takes hours or days to access in your new system.

You should also ask in advance about any associated software or EMR fees, and find out whether these are billed through the billing company, or to the software provider directly.

Things to ask a medical billing company:

• Will I have to change EMR?
• What new software do we need to use?
• Will my staff get training?
• Will outsourcing maintain HIPAA compliance?

Red flags to look out for

🚩 RED FLAG #1

They only offer pre-made contract options

Your outsourcing partner should work with you to meet your unique, individual needs.

Every medical practice is different. When you look for an outsourcing partner, you need to understand exactly what you need from them, and create a contract that reflects these realities. If the company that you are looking at only offers inflexible contract options that don’t reflect your actual needs, you are better off looking elsewhere, even if the company looks good in some other regard.

It can be difficult to think about what kind of contract you want if you’ve had full control of the billing process so far. Make sure to have a good understanding of this going into the negotiations. Make sure to ask about information and records exchange, how their rates are calculated, payment scheduling, contract length, software compatibility, training schedules and methods, as well as any other specific issue that pertains to your practice.

🚩 RED FLAG #2

High staff turnaround

Consistency with staffing means consistency in your collections.

Make sure to ask about the staff turnaround at the company you are outsourcing from. At the end of the day, it is the staff that does the billing that gets you paid, and the knowledge in their head is what will bring your collections up. If they are changing out their staff frequently, your collections could end up being inconsistent.

This can seem like a strange topic to discuss with a potential outsourcing partner, but it should be normal for you to want to understand what types of people are going to be working for you. You can feel free to ask about how long most of their billers have been with the company, as well as what types of training they have and any additional certifications or specializations that they possess.

🚩 RED FLAG #3

Lack of certification (or few years in business)

Certifications are a sure sign your medical billing company is up-to-date on regulatory requirements.

Make sure that the company you outsource with is certified; it’s as simple as that. There are multiple types of certification that you can look at – CMRS, AMBA, CMBS – but it is important for them to be certified in order to offer consistent, robust collections for your practice. Make sure to ask about this in advance – which certification do the billers have, is it universal throughout the company, as well as any follow up questions about how they deal with certification updates and changes in billing regulations.

Ready to work with a medical billing company that will work with your individual needs? Contact our team to learn more.