How to Select Medical Billing Vendor Colorado

Steps

1. Scope of Services.
   • Scope of services may include complete practice workflow starting with appointment scheduling to electronic medical records, SOAP notes, and billing, or it may only be focused on billing.
   • Billing too may be limited to just electronic submission, add validation, or include payment posting, reconciliation, followup, secondary submission, and patient billing.
   • Each aspect mentioned above should be ranked according to specificity and coverage.
2. Compare Billing Models.
   • Is it an aggressive or a defensive billing firm?
   • Which of the following functions are automated: upfront validation, submission, reconciliation, and follow-up workload allocation?
   • Which specific errors are handled automatically at the upfront validation level?
3. Compare Reporting.
   • Operational Report shows total claims and $ amounts submitted, paid, adjusted, written off, and failed. It allows breakdown by cpt, payer, referral, or a combination of such dimensions.
   • Denials Report shows a list of denied claims and a log of followup actions. By sorting it by amount paid, you can tell the smallest payment the billing service will fight for.
   • Reporting Frequency: What is the turnaround time for new reports? How frequently can you receive the reports? What is the method to access them?
   • Data Aggregation and Analysis: If web-based access is available, do the reports allow drill-into more detail? Is it possible to refine and sort reports on-line and along multiple criteria? Is it possible to export to Excel spreadsheets for further analysis?
4. Compare References.
   • What do current clients think about the quality of service? Can a client comment about any of the criteria on this list as well as cite specific improvements over time?
5. Compare Billing Service Quality.
   • What aspects of the billing process are measured? Do they include separate collections and payment delay measures? How is delay measure defined: does it measure the time elapsed from claim creation until payment by the primary payer or does it start at service delivery and measure the entire period until receiving payments from both payers and the patient? Is a histogram of payments available for client review on a periodic basis?
6. Compare Billing Process Quality.
   • Which processing quality metrics collected? Do they include coding, submission, and follow up delay metrics? Do the metrics include both claim stats as well as fiscal value statistics?
7. Compare Billing Transparency.
   • Can the candidate billing firm readily provide quality metrics and access to every step of the billing process on a continuous 24 x 7 basis over the Internet? Transparency is a critical aspect of outsourcing billing service because without transparency the service may not be reliable.
8. Compare Compliance Features.
   • Does the billing company have a compliance program in place? Is there a Code of Conduct?
9. Compare Communications Protocols.
   • Is there a formal and simple process to report problems and track their resolution? Is there a competent account manager? How often a meeting is held to review outstanding problems?
10. Compare Technology.
    • Does the firm offer access to specialized technology? Does it require software installation and maintenance or is it available on the Internet using a standard browser?
11. Compare Measures for Data Security and Protection.
    • What are data center facilities? Is the technology HIPAA compliant? Is the access to the claims secure? Is data protected? What are disaster recovery facilities? Is there a regular backup process? At what intervals? Where is the backup data stored?
12. Compare Data Entry Protocols.
    • Is Superbill available online? Can the claims be just faxed? Is there a separate form for patient and charge entry, EOB posting, and on-line claim editing? Are any of the claim validity tests available during data entry?
13. Compare Processes for Continuous Improvement.
    • How does the firm identify systemic errors? How does it ensure that previously made mistakes do not repeat?
14. Compare Scalability.
    • What billing process steps are automated? Can the firm take on another client without impairing service quality?
15. Compare Size.
    • What are the firm?s gross annual billings? How many claims does it process annually? How many practices is the firm billing for? What specialties does it currently handle?
16. Compare Staffing.
    • How large is the staff and what is the reporting structure? What is the educational background and experience of staff and management? Would adding your practice require the billing firm to hire additional staff?
17. Compare Responsiveness.
    • Consider technical systems access and problems beyond late AR or incomplete payment. How quickly does it take to respond to a technical problem notification? How quickly does it take to resolve a problem?
18. Compare Pricing.
    • Most billing firms charge for services a percentage of monthly collections. This percentage varies among specialties, depending on the average claim billing size and claim volume. Note that the lowest cost provider is not necessarily the best. It is in the physician?s interest to see that a quality billing service makes an adequate profit. Otherwise, the billing firm will be forced to reduce the amount of effort spent on supporting the practice, resulting in lower quality.

Warnings

• Focus on quality. Remember that 10% improvement in quality means 10 times more to your bottom line than 1% reduction in price.
• 59% DO NOT review or verify every EOB.
• 55% have NEVER appealed a denied claim

Sources and Citations

• Medical billing technology
• Specialized Chiropractic Billing
• Audit Risk Webinar
• Medical billing software
• Web based EMR and Medical Practice Management Sofware
• Advanced medical billing service
• Wiki for medical billing concepts
• Billing Search Engine
• OfficeFrogs, Inc. Washington State billing

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