While these are undoubtedly amongst the most significant aspects, there is still more to the whole picture. You’ll want to know their level of experience in medical billing, if they are HIPAA compliant, the kind of reports they would generate and how frictionless it would be to track and monitor those reports… and much more. This article is a deep dive into eight of the most important elements of an RCM service provider and why you need to ask these questions before you sign a partnership with them.
You need to partner with a Medical Billing Company with hands-on experience in handling multiple specialty and different Billing software, and has certified coders who have in-depth knowledge on the norms of the CMS guidelines. Unexpected issues may arise at any time and a company with excellent expertise must have already handled these issues and knows best how to tackle them. Needless to mention about the doctors’ shorthand codes that throw off new services.
Ensure that you inquire about the Revenue Cycle Management Company’s history and the average amount of experience its employees have. There are even chances that older companies operate with inexperienced staff, whereas a newer company might staff only veterans.
Also, find out about their specializations. You might want to hire a Medical Billing Company with the experience and expertise working with your specialty in the healthcare industry. Some medical billing and coding companies have a better experience with hospitals, whereas some with primary care physicians.
Protecting patient Health Information (PHI) is one of the top priorities for any healthcare organization. Checking on the HIPAA compliance would help you gauge their quality and transparency. Also check the measures they take to abide by the HIPAA Policies; this will give you the confidence to make a wise decision in choosing an outsourcing partner.
Also check on their certification equal to HIPAA for data security and management to avoid data breach. HIPAA compliance is not always the same; it varies with different legal requirements. The Medical Billing Service Company needs more than HIPAA compliance; it needs compliance officers who can perform periodic audits and generate reports. And educate their team on the compliance every year based on the industry changes.
Data security is also a primary concern; consider raising questions on patient data, email, fax and inter-personal security. Successful companies are those that take security seriously.
Don’t hesitate to get into the details here. Find out from the Medical Billing Service Company on the number of reports they will deliver in a given year. Will reports be provided on a weekly, monthly or quarterly basis? Also, ask them how you can access the reports. Some outsourced medical billing service companies send statements via post, whereas the others give you an online accounts summary.
Ideally, an outsourced Revenue Cycle Management Company acts as an extension of your RCM team and can adapt services based on your unique business needs. You wouldn’t be required to remove your old system and completely replace it with a new and unfamiliar one. There would be some level of flexibility in the matter. After all, no hospital or practice would be willing to retrain the admin staff from scratch.
Alternatively, also remember that you don’t want to be inflexible to an extent where you can’t benefit from the streamlined processes of Medical billing.
Medical Billing Companies usually do not provide alerts on contract related issues. However, you might want to partner with a company that does. By all means, you might want to know if a payer is probably just reimbursing 75 percent, while the actual contract percentage is 120%. This level of alerts and communication between the healthcare organization and its revenue cycle partner ensures that there is no stone left unturned—to optimize the revenue cycle performance.
You’ll need to know the costs and what exactly you can expect for your billing dollars. Some services that are crucial but may be excluded from low-cost service providers can include
- Follow-up on low-ticket claims
- Sending patient statements
- Working accounts receivable – how many are over 90 days?
- Managing resubmitting denied claims
- Alerting provider clients about any contract issues that may arise
A vacation leave or sick leave is bound to happen with every employee. However, you cannot afford to let this affect your revenue cycle operations—a reason why you would hire a dedicated medical billing service provider in the first place. You need to ensure that you get the same level of service even on those days that they are out of the office for whatsoever reasons. Enquire if the RCM Company can guarantee consistent service levels and how they do it.
You can ask for the details of their past or existing clients to get a reference check done and to understand their level of quality, transparency, processes & metrics. It also helps you understand their timely response in addressing queries during any crisis.
Reference check will help you take the final call in choosing the right Medical Billing and coding services company—to gauge their nuances in maximizing the revenue after you choose them as a vendor partner for the support of extra hands.
These questions will help you make the right decision when selecting a Medical Billing Service. It is worth taking your time in the screening process to be assured of the best service possible from the beginning.
SolvEdge is a digital healthcare solution company in the RCM industry that specializes in medical billing and coding services. Our organization has required security certification ISO 27001:2013, which is an additional benefit. We have our process in place along with an experienced team of certified coders and billing experts (with an average of 5+ years of experience)—to ensure that the business continues even during emergency times.
