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