Now here is where it gets really interesting.
Infrastructure, sustainability, experience, scalability
Me: Now that all assumes that (see one part of this article), from day one, you are certain that your billers are always up to date on all of the updates in coding and never lose days for vacation, sick days, personal, Etc, and that you never have any staff turn over and have to train new staff. It also assures that you have clearly defined metrics by which you will measure the performance of your billers. Finally it asserts that the technology you will use to do all of this is in place and works. My point here is that these are unrealistic expectations and without the experience of managing billing for hundred of doctors or processing millions of claims, managing the people to do that and putting the technology in place you are fighting a losing battle. The time it will take you to find and keep the right people, develop processes and metrics, and implement the technology to manage all of this is impossible to calculate. The cost of focusing on this instead of building your patient base is also impossible to calculate since every patient earned today could mean tens of thousands of dollars through the life of your practice between the revenue they bring and the other patients they refer.
Me: Obviously I would like you to choose my company as your billing company, but there are some questions you need to ask any billing company before you hire them.
Doc: Like what?
Here are my top 10 questions you should ask when interviewing an billing service:
- How many providers do you currently bill for and in how many states?
- How do they stay on top of new coding rules?
- What does a normal day look like when you are their client?
- How long have you been in business?
- What was the largest number of clients you have added at the same time?
- How many claims do you process on a monthly basis?
- How many billers do you have on staff?
- What is your process to add new billers?
- For small companies: What is the hierarchy in your company? What is something happens to you?
- What will you do to help me stand strong in face of an audit?
Let's look at each of these questions. These are just a few questions. Use them as a way to set your focus. Understand their intention and use them as a guide to come up with some of your own.
1. How many providers do you currently bill for and in how many states?
Tells you if this a mom and pop or a large scale, sustainable operation. A company that bills for docs in 3-8 states is probably smaller, 1 state is way too small. They will not have the experience you need. Seeing billing trends nationally is an important part of knowing what will happen in your area. One change made by a carrier in X state might possibly be adopted in other states by other carriers. Without many carriers in many states they will just not see a potential disaster coming. A large number of client means they will have likely heard them all, questions that is, and have the answers you need. It is also very likely that the more clients they have the more efficient they have become in doing what they do and have experience with growth. The worst thing that can happen to a billing company is they die because they took on more work than they could grow with.
2. How do they stay on top of new coding rules?
This is key. Most billing companies rely on one lead person or owner to know all of the rules and manually check claims when they go out for coding errors, and data entry errors an when claim is paid that same person is in charge of staying on top of the Denial reasons. There are several inherent problems with that.
- Looking at every denial reason and reacting means that that person is not looking from a birds eye view at numbers of denials based on reason. If they were they would be able to better react.
- Typically there is no automation. There is technology that can read EOB's electronically including denials and underpayments, rout those tasks to workbenches for follow up and in some cases automate the response all while updating AR and denial reports in real time.
- If that one person is out for a day performance suffers and a backlog builds. You usually can not see this back log. Web based technology allows you to see the backlog in real time and know when you team is not doing its job.
- Manual checks are not reliable. When errors are found either either result in changing of codes by the billing company, which is illegal, or an email, fax, or phone call to your office. This is a disruption to the normal flow of your office. Your practice management system should warn you as soon as you enter the code incorrectly so you can correct it before submission and in some cases drive that task to a workbench so you can get to it when you have time and so it will not be lost like Emails often will be.
- Rules change rapidly in the insurance industry and being able to see trends is very important. Attending medicare suspects is important but it is only one piece of staying ahead of the curve. Having a network of hundreds of providers submitting through one system allows for trending reports which enable a billing company to see not only what is happening for your area but across the country. It also enables them to get feedback from doctors about the unadvertised reasons claims are being denied. Having this type of centralized technology allows for a rules engine to check every claim going out for errors and automate the appropriate action before submission. When an EOB is read electronically it also manages the work flow. One last technology is like this allows the availability to rank payers. Are they unfairly denying claims? The billing company can audit the insurance companies on a large scale. One biller just can not do that.
3. What does a normal day look like when you are their client?
How will claims be sent to them? Will you have to fax a stack of claims? How long will it take for that stack to get billed and do they guarantee that? How will you know they did not lose one of those claims? If there is a problem how will they tell you about is, phone, fax, email? When will they send you reports? When will they bill you? In other words, will it be easy for you to deal with them or a burden? Will you be sure that every claim is submitted and ever claim that needs follow up will be followed up on? When things go wrong how easy, transparent will they be to see? Will it disrupt your practice? If your not happy with your account manager how easy is it to replace them?
4. How long have you been in business?
Have they been lucky with their success or do they have a proven track record. Will they be there for the long term relationship?
5. What was the largest number of clients you have added at the same time?
Again, can they grow? Can they add clients without sacrificing quality or will they be a victim of their own success?
6. How many claims do you process on a monthly basis?
This will give you an idea of the scale / size of the operation and also if they have to check on that number they are not measuring things. Billing quality is a business that should be measured by numbers. Any good company should know this off hand or know the person who knows the number and be able to get it in a hurry.
7. How many billers do you have
Size and efficiency. If they are telling you that they process 50,000 claims every month but they have staff of 6 you know quality is low. Just for a reference, my company processes 80,000 claims per month and has a team of 70 billers and 5 billing managers not counting partners.
8. What is your process to add new billers?
This will tell you if they run this service like a company or by the seat of their pants. Managing billing teams should mean that the billing company has a clearly defined process to add billers at a moments notice without much notice. In reality they should be constantly adding resources and allowing them to work their way up the ladder to follow up. Some companies will just hire anyone answers a Craig's list ad that week.
9. For small companies: What is the hierarchy in your company? What is something happens to you?
I a small company where is it basically a one man / woman show, you could be at the mercy of the owner. Billing is a highly competitive and stressful industry. That being said companies go under and owners quit. How Are you certain that with this company that no matter what happens to the owner there is a back up plan? Does that one person play a key role in all aspects of operations? In other words do they actually post EOB's and call insurance companies or have they built infrastructure that will stand strong in their absence?
10. What will you do to help me stand strong in face of an audit?
Will this company give you real time reports to show you your red flag profile? Can they help show you where you are putting yourself at risk? Will they give you a web based documentation system that is fast and easy to use and that is built by compliance experts? What is their plan to protect you?