Which Vendor Do I Choose?
Over the last few years, billing companies have been bought and sold, merged, created, downsized, and expanded. Some of the pioneers have come and gone, some have grown, and some has downsized. These changes have been rapid and present new challenges for Emergency Physicians looking for a billing and coding vendor. On the bright side, change has created increased competition which provides more options for Emergency Physicians who are interested in managing their practice in an effective and economical manner. The real question is which vendor to choose and what criteria to utilize.
Most billing and coding companies have very effective marketing materials, skilled marketing personnel, and a solid base of customers to provide referrals. Therefore, how do you decide who to believe and which company best suits the needs of your group? Beyond the obvious compliance issues, ask yourself these basic questions: · Does this company have current or past experience in my market? · What can or will this company do to improve my reimbursement? · What are their claims processing procedures? · Will this company provide timely service? · What is my cost for these billing and coding services?
Market Experience: Billing and coding experience is your market is very important. Having the knowledge and understanding of your market eliminates many potential mistakes made by coding and billing companies. Many states and local carriers have rules and regulations that are unique to that area. Inexperience can generate problems such as delayed obtainment of provider numbers, inappropriate discounts, and difficulty in maximizing reimbursement.
Reimbursement: While many variables that affect reimbursement such as payor mix, patient volume, managed care contracts, and physician documentation are not variables that your billing partner can directly control, the billing partner can and should assist your physician group with the management of variables that affect reimbursement. An experienced billing partner can assist you with managed care contracting, physician documentation, and regular updates and analysis on payor mix, patient volume, managed care contract payments. Monitoring changes in these variables can greatly enhance your reimbursement. When physicians in a group are having their charts downcoded due to insufficient documentation, you want to see examples and arrange training sessions with your billing partner. Downcoded charts result in lost reimbursement that will never be recovered. This type of service is what separates one company from another. Yes, most or all will promise that they provide these services; however, many fail to provide the detail needed to make a difference.
Processing Details: Internal billing company processing protocol for all patient charts can greatly affect your reimbursement. I have seen all types of processing. Unfortunately, some companies tend to do what I call “skimming the cream” and turn the rest to a collection agency. These companies process the Medicare, Medicaid, and insurance companies that pay quickly, while failing to appropriately work denials adequately. The result is a quicker turn to collections for many accounts. When speaking with your billing company, ask for details on how they process all claim types, how many patient statements are sent and how often, when and how they process denials, how quickly they post payments and charges, and what special processing they use for workers compensation and auto liability cases.
Service: As most of you know, timely customer/client service is hard to come by today. Our industry is no different. Finding the billing and coding company that provides timely and proactive service is essential for your group. Ask questions and interview many current and former clients to determine what level of service a company provides. Additionally, talk to peers that have used more than one company and get a comparison. Without service, you will never have a fruitful relationship with your vendor.
Cost: Your cost for billing services can vary greatly depending upon how you are charged. Many companies charge a percentage of collections, while others charge a flat-fee per chart processed. Recently, I have even seen some blended rates where you are charged a flat price for coding and a percentage of collections for billing. Additionally, some companies also charge add-ons for services such as credentialing, mailing of statements/claims, reports, etc. Make certain that you ask the billing company whether their fee is all-inclusive or if they have additional charges. Regardless of the method used to determine billing fees, make certain you understand all of the costs. If your billing company is providing the full spectrum of services, your billing fee will usually range from 8-14% or $8.00-10.00 per chart. Remember that price does matter and you often get what you pay for; therefore, be careful you don't pay less on the fees and receive much less in total collections. The relationship must be a win/win.
Now you must evaluate the variables and decide which vendor fits your group best. Use your resources and make prudent decisions. The relationship with your coding and billing vendor is more important today than ever before.