Practice Management Articles

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Tips on Selecting a Reputable Billing Company 
Sean M. Weiss

Recently, I had the privilege of speaking at a conference for medical billers in southern Florida. Over the course of two days, I spoke on topics ranging from compliance and leadership skills, to increasing collections while reducing denials.

I really think that this group was one of the most attentive, interactive and pleasant crowds I have ever lectured to. Their interests were genuine and their desire for doing things, the right way for their clients was very evident. I was, however, surprised to find that roughly 40-45% of the attendees at this conference were either brand new to the industry or have worked in their current capacity for less than 2 years. This caused me some concern because their inexperience can potentially cost physicians money if the billing services do not know how to code or verify what the doctors offices are providing them as information to bill to the insurance companies. Or they might try collecting for services or levels of services they are not entitled to causing doctors to have to make refunds.

Now, please understand I am not saying all billing companies are this way or even that the majority of them are this way because for me to say that, I would be a fool. There are many experienced and reputable companies out there that work hard to provide a valuable service for their clients.

In the interest of helping physicians find the right fit, I have compiled a list of suggestions for anyone considering outsourcing their billing.

1. Check to see if the company has been reported to the better business bureau.
2. Check to see if any of the officers or employees of the company are listed on the excluded or sanctioned provider lists.
3. Request references from other companies they bill for in the same specialty as yours.
4. Ask lots of questions about what software they are using, ask for sample reports they provide and how often they will be onsite at your office providing you with feedback on how your collection efforts are going.
5. Ask them to explain their appeals process to you and how it matches up to what the carriers use as an appeals process.
6. Do they provide as part of their service annual updates to your encounter forms?
7. Can they negotiate your fee schedule with insurance carriers?
8. Do they have certified coders on staff and if so who are they certified by (PMI, AAPC, or AHIMA)?
9. Have they adopted a third-party billing company compliance program and can they develop one for your group if you do not currently have one?
10. What and how are their fees structured and then compare this to other companies. The most expensive companies are not always the best and going with the cheapest may put you in a position that is not very comfortable.
11. Does the company carry Errors and Omissions Insurance? How much?
12. Are they bonded and insured? How much?

The bottom line here is to make sure to do your homework when choosing a billing company to ensure that you are not taken for a ride. There are great companies led by caring individuals who are happy, willing and able to assist you with your practice needs. Kathy Young, a billing company consultant out of Phoenix, Arizona, was a tremendous reference to me for this article. Also, I had the pleasure of spending time with Ken Engle, a billing company consultant and an educator for billing companies all across the country. Folks like these are the reason the industry has a bright future.

Sean M. Weiss is a Senior Partner and Principal with PMI Professional Resources/The CMC Group; a full-scale medical consultancy, education, products, and legal firm with offices in Atlanta, GA and San Antonio, TX. To contact Sean directly you can email him at sean.weiss@thecmcgroup.net.