Use these best practices to evaluate third-party billing partners and make the best choice for your bottom line
Choosing a billing partner is intimidating — and maybe it should be! An ill-equipped team hurts your practice. On the flip side, expert coders and revenue cycle managers can help your practice thrive.
The challenge, of course, is that everyone is a self-proclaimed expert. How can you be sure you’re finding the support you need?
Once you’ve identified what you need in a billing partner, the next step is to do your due diligence. Taking the extra time to thoroughly evaluate your options saves time, money, and headaches. Here are a few strategies for making sure that billing partners can deliver.
Check References (The Right Way)
Ask to speak with references from other practices in your specialty that are similar in size and scope to your own. If you’re taking on special projects like clearing up aging AR, talk to another practice with a similar situation.
It’s nice if they like their provider, but that alone doesn’t tell you much. When connecting with references, ask specific questions to check your assumptions. For example, your definition of “regular communication” may be wildly different than someone else’s. Asking how they communicate as well as how often gives more clarification.
For example, Gentem schedules weekly or monthly meetings depending on customer needs. Customers have 24/7 access to their data in our platform, but we still review monthly reports together and interpret all changes. If there were denials, we game plan together to identify how providers and front office staff can eliminate similar denials in the future.
Use these questions when speaking with current clients of a potential billing partner:
- Tell me about a time this billing partner helped your practice increase revenue?
- How often do you receive data reports? What information is included?
- Can you give an example of how they improved an existing process?
- How often do you communicate? The last few times you connected with this billing partner, what did you talk about?
- What is this billing partner great at? Where do they have room for improvement?
- Has your account experienced any staff turnover? If so, how was that handled?
You should come away from reference checks with a good sense for whether the billing partner added value or simply maintained the status quo. Listen for any red flags — sloppy work, high turnover, spotty communication — and keep an eye out for strengths that set them apart from the competition.
Ask for an Internal Audit
Once you confirm that the billing partner you’re considering has a good track record with other customers, it’s time to make sure they have what it takes to handle your particular needs.
To learn how potential billing partners interact with your account, it’s a good idea to ask them to perform an internal audit on your data. This gives you a chance to confirm that they are offering accurate, compliant solutions and see how you might work together.
There are two ways to do this. The first is to send frequently used reports, like detailed aging AR reports, transaction reports, and denial reports. Look for how they assess the data and what they tell you about your financial picture. Is their assessment in line with what you already know? Do they seem knowledgeable?
The second option is giving them access to your account. Really excellent partners may even ask you for account access. If potential partners do dig deeper into your data, the bar is higher. You don’t just want them to summarize what they saw in your notes. You want detailed solutions.
A good billing company comes in with the confidence to offer you concrete solutions and recommendations, rather than being stingy with information. Look for an insightful conversation about AR, denials and tips you can implement right away.
This internal audit process will help you identify partners who are eager to educate your team, to share what they know, and to talk strategy.
Consider a Coding Assessment
You want to be able to trust the billing company as a whole, but you need to trust that the person assigned to your team is sufficiently knowledgeable. Particularly if you are evaluating a startup or a billing partner that is less well known, make sure you speak with whoever will be directly responsible for handling your account.
You should make sure the team assigned to your account has sufficient bandwidth and experience; larger or more complex practices should look for a dedicated team and a team lead with significant management experience.
Next, confirm that you will work with Certified Professional Coders. If relevant, you can also request coders certified in your specialty or certified to handle the complex coding of an ambulatory surgery center. If you want extra validation, request a coding assessment from the coder or coders who will be assigned to your account.
To assess coding abilities, send a few real-life, de-identified scenarios from your own practice. Stay away from standard questions you find on Google. Instead, look for edge cases to confirm that they have the knowledge and skills to problem solve.
If you like, consider walking through examples on the phone. Even the most expert coders will look up codes to triple-check details, but a phone call can help you gauge confidence and experience. Your account lead shouldn’t need to read up on the basics.
To test general knowledge, ask open ended questions. For example, “What are three considerations for avoiding medical necessity denials?” will tell you more about how someone thinks than if you simply ask for a list of codes.
Finally, Read—and Re-read—the Contract
When you’re confident that your billing partner has the skills and expertise to meet your needs, the final step is to make sure that you sign a contract that keeps you in control.
Once you’re confident that the provider is able to meet your needs, start with a two year contract. If you have hesitations, stick with a one year contract — or take the time to choose a different provider!
Either way, make sure the contract is clear on how to get out early if needed. You should make sure you are protected if the quality of service changes. For example, consider including a clause allowing you to end the contract early in the case of improper billing techniques, improper follow up, or evidence of significant financial loss.
You should also make sure there is a mechanism for recovery of funds due to poor performance. Confirm that the billing partner would be responsible for reimbursing you for significant loss due to poor performance or negligence.
To maintain patient privacy, you and your billing partner will need to sign a shared HIPAA Business Associate Agreement (BAA). Make sure you have clear safeguards in place to guard patient data and to remedy any violations.
Finally, even with a billing partner you’d be excited to work with for decades, make sure you are clear on the terms of termination. Who will be responsible for patient data when the contract ends? How will data be returned?
You deserve a billing partner who has a track record of excellence in billing in your specialty, who will advocate for your practice, and who will help you grow your bottom line. If you do your due diligence and still have a gut feeling that a provider is not right for you, listen! Hold out for a billing partner that cares as much about your revenue as you do.
This guide does not replace regulatory CPT, ICD-10CM or Payer Guidance, nor does it serve as legal advice. The pocket guide is based on opinions and independent interpretations on how payers may process common orthopedic claims.