people meeting to choose a billing partner

How to Choose a Medical Billing/RCM Partner For Your Practice

Choosing a billing/RCM partner is intimidating — and maybe it should be! An ill-equipped team hurts your practice. On the other hand, expert coders and revenue cycle managers can help your practice thrive.

The challenge, of course, is that everyone is a self-proclaimed expert. So 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 evaluate your options thoroughly saves time, money and headaches. Here are a few strategies for making sure that billing partners can deliver.

Get the Basics

Before diving too deep into the potential partnerhip, make sure you ask a few  essential questions to see if the billing/RCM partner may be a good fit. Start with these:

  • How can you help my practice increase revenue?
  • How often do you provide data reports? What information do you include? 
  • How can you improve my practice’s existing processes?
  • How often will you communicate with my team? 
  • How will you work with my existing software setup (EHR/PM system)?

It would help if you came away from the first conversation with a good sense of whether the billing partner can add value or will maintain the status quo. Keep an eye out for strengths that set them apart from the competition.

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Ask for an Internal Audit

Once you confirm that the billing/RCM partner you’re considering has a good track record with other customers, it’s time to ensure they have what it takes to handle your particular needs. 

To learn how potential billing/RCM partners interact with your account, it’s a good idea to ask them to perform an internal assessment on your data. Asking those questions lets you confirm that they offer 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. Then, 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. Excellent partners may even ask you for account access. The bar is higher if potential partners dig deeper into your data. You don’t just want them to summarize what they saw in your notes. You want detailed solutions.

A good billing and RCM company is confident in offering you concrete solutions and recommendations rather than being stingy with information. Look for an insightful conversation about AR, denials, and tips you can implement immediately.

This internal audit process will help you identify partners eager to educate your team, share what they know, and talk strategy.

Consider a Coding Assessment

You want to be able to trust the company as a whole, but you need to trust that the person assigned to your team is sufficiently knowledgeable. So, 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 ensure the team assigned to your account has sufficient bandwidth and experience; more effective or 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.

Send a few real-life, de-identified scenarios from your practice to assess coding abilities. 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 ask for a list of codes.

Finally, Read —and Re-read — the Contract

When you’re confident that your billing/RCM partner has the skills and expertise to meet your needs, the final step is to make sure you sign a contract that keeps you in control. 

Once you’re confident that the provider can 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, ensure the contract is clear on getting out early if needed. In addition, 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 ensure a mechanism for the recovery of funds due to poor performance. For example, 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 must sign a shared HIPAA Business Associate Agreement (BAA). In addition, make sure you have clear safeguards to guard patient data and 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. For example, who will be responsible for patient data when the contract ends? How will data be returned? 

You deserve a billing partner with a track record of excellence in billing and revenue cycle management in your specialty who will advocate for your practice and help you grow your bottom line. If you do your due diligence and still feel that a provider is not suitable for you, listen! Hold out for a billing partner that cares as much about your revenue as you do. 

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Questions You Should Ask Before Choosing Your Medical/RCM Billing Partner

Has the company you’re considering worked with other practices like yours?

The more experience they have, the more beneficial it will be for you. Some specialties like behavioral health or cardiology are more complicated and you don’t want to pay the price for them to learn the tricks of the trade.

Is anyone on their staff certified and trained?

Billing for medical and mental health services is a skill that calls for training, work experience and continual professional development. Does your billing/RCM company have certified coders or individuals who hold an AAPC certification or a college degree? Has any employee of the billing company finished a training specifically related to that industry?

Your potential billing partner is showing they appreciate this professional expertise and prefer to hire people who take their jobs seriously when they hire certified coders or those who have completed specific training.

Will they help you throughout the whole RCM process, from verification to reporting?

There are many, complicated steps between a patient entering your practice and you getting reimbursed for their care. When your medical billing partner can handle every step of RCM, you’ll see higher claim acceptance rates, less confusion and a more efficient process.

Are they committed to grow with you?

Make sure you are choosing a billing partner who can support you now, a year from now and five years from now. Your business will expand, sometimes quickly, during the next five years, so it’s critical to select a billing solution that can keep up with that expansion. Your billing partner’s ability to grow with you may come down to the functionality of their software. But you’ll also want to consider whether they can handle your practice’s volume of claims or invoices. .

Do they offer high-quality support and customer service?

You don’t want to set up a billing solution incorrectly and it’s not a one-size-fits-all process. It’s critical to guarantee your implementation will have the proper level of support, and that support will stay consistent throughout your partnership.

For example, Gentem schedules weekly or monthly meetings depending on customer needs. Customers have 24/7 access to their data on our platform, but we still review monthly reports together and interpret all changes. If there were denials, we plan together to identify how providers and front office staff can eliminate similar denials in the future.

Do they give you full access to all your practice’s financial data? 

Many billing and RCM partners keep your practice’s data locked away, or don’t give you the complete picture of your practice’s financial health. Having access to this data will help you make critical decisions about the growth of your business. 

Is their platform easy to use? 

Anyone who has worked in healthcare knows how complex software can get. If your billing/RCM partner has a user-friendly platform, your practice will be able to get up-and-running faster, and will face fewer snags in the RCM process. 

Do they allow you to customize parts of the RCM, or do you have to fit into a specific setup? 

Every practice is different and only you understand what’s best for your business. It’s critical to find a partner that has billing features and RCM worfklows that you can customize to fit your needs and patient population. 

Are they proactive in optimizing your RCM? 

Your billing/RCM partner should be looking out for your practice’s best interests and exploring ways to improve, not simply reacting to problems. Ideally, you’ll find an organization that is focused on continuous improvement and education, so your practice can maintain a healthy RCM while finding opportunities for growth.

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Many physicians are leaving private practice due to rising costs, lower reimbursement rates and staffing shortages. But staying independent is possible with a healthy revenue cycle.

Learn how to run a successful private practice with tips from this 20-minute webinar session.

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5 Must-Know Metrics To Build A Thriving Medical Practice

With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

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