Billing PixThe first step in finding the right billing service, whether automated or live, is to decide what it is you need and want and then what the service provides. Some key points to assess should include:

  • Do you need insurance submission?
  • What kind of reports do you need (e.g., accounts receivable, payor mix, income by referral source, by CPT code, by clinician)?
  • Do you need to be able to bill multiple parties on a particular case and keep track of their balances?
  • Does the service help you register for panels and Medicare?
  • Does the service offer electronic submission?
  • What is the delay in submitting claims?
  • How do they handle denials of claims?
  • Do they have someone available to you that you can review your accounts with as part of the service?
  • What is the fee structure and are things like reports and setting up separate insurance or provider profiles extra?
  • What kind for reports does the service routinely send you (that are included in their regular fee)?
  • Does the service process credit card transactions (and is there an extra fee)?
  • If you leave this service in the future how do you get your billing data and is there a financial penalty for leaving the service?
  • What kind of data security and backup systems do they have in place?
  • What is their average collection rate?
  • Are they willing to sign a HIPAA Business Associate Contract?

Then compute the fee based on your needs and their fee structure. Some companies will charge a percentage and will compute that percentage based on your total collections. Others will base it on only the insurance collections (but include copays paid to you and monies paid directly to the client). It is very important to be sure you know exactly how the fees are calculated and then estimate the fees so as to avoid surprises later.

Find some references who have used the service and see what their experiences have been and what questions you should ask before signing the contract.

Also, read the contract. Make sure it spells out the billing service's responsibilities, not just yours. The service is providing a service to you and you are paying for that service.

Your billing service should be a tool to enhance the running of your practice, not a headache.