Selecting a Billing Service. What to Look for When Selecting a Billing Service

Transcription

1 Selecting a Billing Service What to Look for When Selecting a Billing Service

2 Overview 1 The best medical billing services do far more than just process claims. They follow up with insurance companies, appealing denials and working rejections, no-pays and slow-pays. They offer collaborative tools designed to boost your revenue. They manage patient payment plans. They handle monthly statement cycles. They provide solid insight into your practice s financial health. Your medical billing service should have solid financial reporting features. They should be able to offer your practice an integrated EHR system that seamlessly shares critical encounter information and automatically transfers charge slips between your office and their billing center. What Questions to Ask During Your Selection Process Before you start your search for a medical billing service, understand what you need. Most salespersons if they re doing their jobs right will tout an encyclopedia of fancy features that you haven t even considered. Be wowed by them, but don t be moved by them! An important question perhaps the most important to ask prospective billing services is: What procedures do you have in place to decrease denials and increase coding accuracy? First, establish a set of key questions and requests that you make of all billing service candidates during your selection process. Here s a starting point for creating those questions:

3 2 1. Ask your billing service candidates for a free revenue cycle management analysis. 2. Review the results of this analysis to determine where the inefficiencies are in your processes. Have salespeople explain how they will solve those problems for your practice. 3. Know what reports you currently rely on for financial insights. Ask the billing service to review the key management reports they typically provide to their clients; Inquire if the billing service can replicate the reports you currently use. 4. Ask for case studies and contact information of other clients so you can understand what the service provider s strengths and weaknesses really are. If you compare these strengths and weaknesses to your culture, your baseline needs and your current inefficiencies, you should be able to identify the best service provider rather quickly. 5. Require the billing service to walk you through their techniques and processes for monitoring and managing insurance claims submissions and postings, and for managing patient payments and payment plans. a. Scheduling. What solutions do they provide to help your office more efficiently schedule and manage patient visits? Be sure to ask for a demo and have your front office staff participate in the review? Is it easy to train on? Will the billing service assist you in training new staff? Are training videos and easily accessible help files available? Does the scheduler integrate with the billing center to facilitate reconciliation of daily encounters with the claims processed for that day? b. Check-in/out. Does the application prompt for co-pays, deductibles and insurance cards? c. Charge Capture. Can the physician encounter interface be customized? Are charge slips automatically delivered to the billing center? d. Payments from payers. What tools are in place at the billing center to manage and track a clean claims submission process, identify denials, and track patient payments? e. Money in the bank. Do they have automated remittance and EOBs? What is their experience/ history in reducing average days in A/R for other clients? What reports/ key performance indicators are available to you and your practice, and how frequently are they updated? 6. Get clear on pricing. There are several pricing models generally found in the industry. What you are looking for is the pricing model that aligns the billing services interests with yours. The model that best meets that criteria is to pay as a percentage of revenue collected. The more they collect on your behalf, the more they get paid.

4 3 Regardless of the solution you pick, be sure to ask your service provider to guide you through the methods they use to capture more revenue at crucial moments during the revenue cycle. Be sure to stick to your guns in knowing what you need and the questions you will ask. It s imperative that a medical billing service understands your practice in great detail. The right company will be able to integrate into your practice as a trusted business partner without causing you major headaches. If you can t trust them or if the service requires too much heavy lifting on your end, then they re probably not the right partner. How to Find Medical Billing Service Providers While surfing through Google will give you plenty of results for medical billing services, your selection efforts will be more fruitful if you use one or both of the following approaches. 1. Ask industry peers. It may be simple, but it can save valuable time. Be sure to qualify their recommendations by starting with peers who: a. Practice in the same state b. Practice the same specialty c. Handle roughly the same patient volume as you 2. Use a matching service, such as AdvancedMD s AdvancedBiller program, that recommend multiple billing service providers that serve your state, specialty and other criteria. The added benefit of using a service like AdvancedBiller is that you save significant time by filtering for the right type of biller from the start, instead of wandering around the Internet hoping to find the right biller. All billers in the AdvancedBiller network are on leading edge technologies that enable them offer you clinical solutions that are integrated with their billing modules, making for a more efficient end-to-end practice management solution.

5 4 To find up to three AdvancedBillers, matched to your profile criteria, start here. Electronic Health Records (EHR) Going paperless with patient records, charge slips, prescriptions and charts is becoming more of a necessity than a luxury with meaningful use looming in the near future. For many practices that haven t already adopted an EHR solution, the question is when, not if. Still, others have an EHR solution have not adopted an effective billing solution. When considering a billing service, consider the following: Can they offer an integrated clinical and billing management platform? Do the two run on a single, integrated platform? If your practice has already settled on an EHR solution, check to see if the EHR will play nicely with the prospective billing service platform. Ask how patient data is secured, backed-up and stored. Web-based EHR+PM solutions, like those provided by AdvancedBillers offer remote/mobile access to patient records and financial management reports. This helps physicians optimize their practice even when they aren t at the office. Determine if this is something your practice can benefit from before making your final decision. Why Outsource Your Billing Now? Four trends are largely driving more and more practices to seek a third party billing service:

6 5 Industry shift to higher deductibles insurance plans and rising unemployment, leading to greater numbers of uninsured patients Increasing complexity among insurance providers Changing government regulations (Meaningful Use, 5010, ICD-10) Evolving technology to keep up with these changes Although insurance and government stipulations have arguably been made in the name of patient care, the overall effect is that it has forced physicians to spend more time on administrative functions and less time with patients. Moreover, inconsistent billing rules have created significant barriers for physicians to receive full compensation on an ongoing basis. Perhaps the biggest challenge to hit the private physician more recently is the problem of collecting on patient payments. Now practices have to contend with collecting $1 of every $4 directly from patients, reports the MGMA in its April 2010 issue of Connexion magazine, based on research results collected in its Fall 2009 Practice Perspective on Patient Payments survey. Participating practices reported that 23.2% of total patient services revenue is attributed to collections from patients. Practices report that collecting from self-pay, high deductible health plans (HDHP) and/or health savings account patients was the fourth most challenging issue they face in managing their practice today. In fact, 60.1% of respondents in the 2009 MBMA Medical Practice Today: What Members Have to Say research reported that is was a considerable or extreme challenge to collect patient payments, which is up from 30.1% in In short, doing it yourself has become twice as demanding as it was in 2008, causing more and more practices to look to third party medical billings companies to handle their patient billing and soft collections. The end result is a considerable net loss of revenue due and an increasing amount of time a practice must spend on revenue management. Again, according to MGMA conducted surveys: The average percentage of total account receivables (A/R) attributable to patients has increased to 26.3%. The percentage of practices that offer and manage payment plans as a last effort before sending to hard collections is now 45.7%. The average percentage of total A/R from patients written off as bad debt expense during the past fiscal year has reached 11.3%. For those practices that continue to manage their own claims processing and revenue collections, consider the findings from Physicians Practice (Feb. 2010): Physicians spend three weeks per year on average dealing with billing issues when they bill themselves.

7 6 Even worse, their nurses spend 23 weeks a year addressing billing issues. The average fully-burdened cost of a certified coder is $53,700 per year. When you outsource your billing and revenue management, you and your staff are now freed-up to spend more time on patient scheduling, patient visit reminders and patient care. Additionally, your revenue cycle management partner can help you capture more revenue at every step of the claims processing cycle. Great medical billing services have numerous automation tools that help them more efficiently process and track claims submission, as well as effectively work claim denials. They have automation tools that help them manage patient payment plans. They are able to offer your practice access to fully integrated scheduling and EHR tools that automate the flow of patient visits and charge slips directly into their claims processing and patient payment tracking systems. If your practice is seeing a steady decline in average annual revenue collected, and your staff is getting worn down and exhausted from trying to collect on what is due, now is the time to evaluate and select a billing partner. Conclusion In the end, you want a medical billing service provider that can manage your claims processing and patient payment processes. Look for a service provider that has a flexible, scalable technology platform that can accommodate future regulations/requirements (Meaningful Use, 5010, IDC-10), as well as growth within your practice. Before you begin your search, get clear about the key functions and reports your practice needs to effectively operate. As the first step in your search, ask for a free revenue cycle management analysis. And remember your goal is not necessarily to offload your problems, but to hire a firm to solve your problems. For this to happen, you must find a billing partner you can trust and work with. Finding the right match for your culture and needs is what the selection process is all about.