Outsourcing to a professional medical billing company to manage your practice’s reimbursements can be both a blessing and a curse. In most cases it will save you significantly in payroll, staff time, and administration headaches, but it can also feel like you’re giving up all control of your revenue. As practices consider their options for managing medical billing, it’s important they find (and maintain) a comfortable sense of control over operations. Here are a few mechanisms of control your medical billing company should offer to show you that the work is getting done efficiently and effectively.
Consistent reporting Consistent reports should be standard for any medical billing company and are your foundation for control over practice revenues. They should be provided at least once a month and include tracking of transactions, A/R, managed care and capitation utilization, and individual provider reports for practices with multiple doctors. Any medical billing company worth your time should also be able to respond to reasonable requests for customizable reports as well. Reports should be clearly designed to give you a concise understanding of the successes and shortcomings of your practice and medical billing company.
Comparative Analysis Monthly and periodic reports are helpful in assessing what has taken place over a given time frame, but comparative reports will truly show the ebb and flow over the longer term. You will have a greater understanding of your practice and the performance of your medical billing company if you are able to clearly see improvements to your cash flow over time identify periods of lagging profitability. Make sure your medical billing company is able to furnish you with comparative reports monthly, if not at least quarterly or annually.
Performance Metrics Performance metrics will often be built into a medical billing services contract, but you should have a mechanism in place for measurement. An example of a solid performance metric would be: 98% of all claims submitted to the carrier within 48 hours of receipt. This is an attainable measurement in most cases, and almost all medical billing software packages can report on submission date for comparison against the date of service. Periodic spot checks of performance metrics will give practices further control over day to day operations and tasks – and not just monthly trends from the periodic reports.
Reimbursements Sent to the Practice When working with a medical billing company, there are a number of ways in which payments can find their way to your checking account. First – not always the number one choice for that heightened sense of control – payments can be sent directly to the medical billing company. While it would be rare that a medical billing company would do something illegal with the payment (and for very little long term benefit), some practices feel this gives away too much responsibility. Another option is to set up a lock box at a local bank. Lock boxes ensure an added sense of security as all mail is received, opened and sorted by bank personnel – but they add often unnecessary steps and time to the process. The most common option for greater control over your payments would be to have all reimbursements sent directly to the practice. The medical billing company can continue to update A/R based on copies of EOBs if necessary, but you never have to worry about misplaced or misdirected checks if you are receiving them directly.
Patient Information While the EMR revolution is building, many practices are still moving around enormous amounts of paper. If you are among these, you will need to communicate your patient information to the medical billing company in such a way that you retain copies or originals of encounter documents. Typically, encounter information is sent via fax or mail mail. If mailing patient encounter information to your medical billing company, consider retaining the originals and sending only copies. Though rare, there is always the possibility that it might get lost in the mail, or the medical billing company could misplace a record. Also, with a more advanced medical billing company you will find scanning or imaging of all documents that come into the office is not uncommon – and they can usually send a monthly CD back to your practice for an extra, electronic copy of patient information.
Access to Data More advanced medical billing companies can also offer practices access to data via VPN (Virtual Private Network) connection or via web portal. Such systems are capable of offering real-time, or near-real-time, access to data and allow client practices to view everything almost as it happens – including daily reports, status of claims, patient balances, etc. Keep in mind that such services do not come inexpensively; they require regular maintenance by very savvy staff.
Contract Terms Finally, if your billing service does not provide you with a way out of their contract – be it with 30, 60 or 90 days notice – then think about the relationship carefully. Are you getting locked into something you might not be satisfied with just a month down the road? Your medical billing company should have an incentive to keep you happy as a client. The service provider whose willing to give you the “out option” with short notice is most likely more confident of their services than the one seeking to tie you down for six months or a year.