| Over four thousand vendors of medical billing | | | | without formal certification from New Jersey |
| services offer solutions to medical practices | | | | Department of Banking and Insurance. 5. |
| nationwide in response to poor in-house billing | | | | References Ask for a list of references owning |
| performance and increasing regulatory scrutiny of | | | | similar practices. Are the clients satisfied with |
| billing processes. On one hand, such a large | | | | results, support, and changes over time? Can |
| number of outsourced billing solutions ensure | | | | they quantify billing service quality in terms of |
| continued competitiveness in terms of both | | | | Accounts Receivable over 120 days and |
| service quality and pricing. On the other hand, the | | | | underpayment reduction? 6. Billing Service Quality |
| lack of uniform service standards and metrics | | | | Make a list of metrics used by the service. Focus |
| among the vendors, combined with their large | | | | on collections completeness and payment delay. |
| numbers, makes the process of vendor selection | | | | Can the vendor quantify the differences between |
| difficult and error-prone. While the availability of a | | | | payers and between various CPT codes in real |
| large vendor selection allows finding an alternative | | | | time? Does the vendor follow up every denial? |
| to unsatisfactory service, billing vendor-switching | | | | What is the denial followup success rate? 7. |
| costs remain high, motivating extra effort and | | | | Compliance Consider two aspects of compliance, |
| focus during the stage of vendor selection. This | | | | namely, your practice and billing service. Request |
| article outlines basic thirteen-step guidelines for an | | | | to review a written compliance program for the |
| effective and efficient medical billing vendor | | | | billing service. Ask for its update procedure. For |
| selection process. 1. Scope of Services Decide if | | | | your practice, request an interface to a legal |
| you are looking for billing technology, billing service, | | | | service specializing in post-payment audit risk |
| or practice workflow solution. If you plan to | | | | management. 8. Communications Protocols A |
| manage billing in-house, you may only need a billing | | | | disciplined vendor has a formal and simple process |
| technology solution. In that case your next | | | | to report problems and track their resolution. Your |
| decision is whether you wish to own the | | | | practice must have a competent account |
| technology or to rent access to it.Complete | | | | manager and regular meetings scheduled to |
| practice workflow solution belongs to the other | | | | review outstanding problems. 9. Data Security and |
| end of the spectrum of services and starts with | | | | Protection Review data center facilities. Ask for |
| appointment scheduling and includes electronic | | | | evidence on HIPAA compliance: claims must be |
| medical records, SOAP notes, and billing. Few | | | | viewed only on the "need to know" basis, access |
| vendors today offer such integrated packages as | | | | to claims and modifications must be thoroughly |
| they require powerful vericle-like technologies used | | | | documented. Data must be protected with |
| by trained and skilled personnel implementing | | | | redundant disaster recovery measures. Review |
| rigorous and disciplined service processes.A | | | | backup process, backup intervals, and data |
| billing-only service belongs to the middle ground | | | | restore capabilities. 10. Data Entry Protocols |
| between the choices described above and may | | | | Modern technologies allow the doctor to take |
| include coding, electronic claim submission, | | | | over coding and reduce the billing role down to |
| "scrubbing" (validation), payment posting, claim and | | | | claims processing and followup. |
| payment reconciliation, followup, secondary | | | | Technology-competent vendor will supply your |
| submission, and patient billing. 2. Billing Model Billing | | | | superbill online, along with a separate form for |
| model selection is the second most important | | | | patient and charge entry, EOB posting, and on-line |
| decision in your definition of desired vendor. What | | | | claim editing. Similarly, much of data entry validity, |
| is the policy of followup process prioritization? | | | | including some of claim scrubbing will be done |
| Who decides on which claims to followup? Which | | | | online at the point of data entry. 11. Processes for |
| of the following functions are automated: upfront | | | | Continuous Improvement A successful vendor |
| claim validation, submission, reconciliation, and | | | | must have developed an effective process to |
| follow-up workload allocation? 3. Reporting and | | | | identify and resolve systemic errors. Without such |
| Transparency Transparency is a critical aspect of | | | | a process, the vendor will lose competitiveness |
| outsourcing billing service because without | | | | and you will have to switch the services at a later |
| transparency the service may not be reliable. To | | | | stage. 12. Size and Scalability Automation defines |
| be able to observe every step of the billing | | | | scalability. The more steps are automated, the |
| process on a continuous 24 x 7 basis, reporting | | | | easier it is for the vendor to take on new clients |
| must be available using a secure HIPAA compliant | | | | without impairing service quality. To understand |
| connection over the Internet.The ability to provide | | | | vendor's scalability, you must compare gross |
| timely and useful reports depends on billing model | | | | annual billings, claim volumes, and numbers of |
| (see above) and billing technology. Vendors that | | | | doctors. Avoid vendors that would have to treble |
| manage their own billing technology typically have | | | | their scale because of serving your practice. 13. |
| better control of reporting capabilities in terms of | | | | Staffing Review staff numbers, educational |
| scope, analysis, frequency, and transparency. At | | | | background, experience, and reporting structure. |
| the minimum, the following features must be | | | | Understand the process of quality assurance and |
| available: Operational Report shows total claims | | | | accountability. Avoid vendors that would have to |
| and $ amounts submitted, paid, adjusted, written | | | | double their staff to serve your account. 14. |
| off, and failed. It allows breakdown by cpt, payer, | | | | Pricing Most billing service vendors charge a |
| referral, or a combination of such dimensions. | | | | percentage of monthly collections. This percentage |
| Denials Report shows the list of denied claims and | | | | varies across specialties, depending on the |
| a log of followup actions. By sorting it by amount | | | | average claim billing size and claim volume. Note |
| paid, you can tell the smallest payment the billing | | | | that the lowest cost provider is not necessarily |
| service will fight for. Compliance Report shows | | | | the best. Read our companion article on relative |
| the potential for post-payment audit and itemizes | | | | value of billing quality and price-performance |
| compliance violations. Reporting Frequency defines | | | | relationship.Yuval Lirov, PhD, author of "Mission |
| the data update intervals on existing reports and | | | | Critical Systems Management" (Prentice Hall, |
| turnaround time for new reports. Data | | | | 1997), inventor of multiple patents in artificial |
| Aggregation and Analysis must allow arbitrary | | | | intelligence and computer security, and CEO of |
| data aggregation and drill-in. Export to Excel | | | | Billing Technologies. Vericle delivers comprehensive |
| spreadsheets for further analysis is a very useful | | | | practice workflow engine that integrates patient |
| feature. 4. Certification Request formal | | | | scheduling, electronic medical records (EMR), billing, |
| certification of compliance with basic regulatory | | | | transcription, and compliance management. It |
| requirements. Stay away from national vendors | | | | improves billing performance and reduces audit |
| with New Jersey clients or New Jersey vendors | | | | risk. |