Choosing a medical billing service

Deciding which medical billing service provider to work with is more than a matter of checking features off a list and comparing prices. You'll be entrusting this provider with a central component of your practice's success – in some ways they become an extension of your own office. It's critical to choose a company that you can work with closely.

A good starting point is looking for providers with significant experience – including familiarity with your type of practice. You don't want to be the only chiropractor among your provider's clients, for example. This ensures that the service understands the codes and procedures that apply to your specialty.

Nor do you want to take a chance on a provider who's just getting into the business. Make sure the provider you work with has a track record of successful billing. More specifically, verify that they're familiar with the insurance companies you work with most and have experience in the states you cover.

Because they handle personal health information – protected information under HIPAA – all medical billing services must be 100% HIPAA compliant. They're covered through a "business associate agreement" that allows you to send protected data to them.

Also, verify that the provider can handle the newer National Provider Identifier (NPI) system, which assigns a unique 10-digit number to all health care businesses for use throughout the insurance system. The NPI system is already being implemented, and every health care provider, insurer, and clearinghouse is required to use it to by May 2008. While the rollout of NPI may face ongoing delays, your billing provider should be ready for it.

Overall approach

The provider should give you a good sense of their overall approach to the billing process. Some stress the technological advantages of their software, while others emphasize the expertise of their staff in resolving denied claims. Choose a provider whose strengths complement your needs.

Ultimately, the success of their collection efforts depends on the quality of the entry work your staff does: if you don't give them good data to start with, their job becomes much more difficult. They should work to help improve the coding and processes on your end, as well as offer detailed reports that can streamline your collections.

Medical billing service expertise

The provider's billing specialists will heavily influence the overall success of your outsourced billing. Find out what training the service provides for their staff – top-notch providers offer continuous education to keep their employees on top of changing codes and insurance regulations.

Ask how the service is set up: some will offer you a dedicated account manager who will manage all your interactions with the service; others have specialized teams dedicated to handling specific parts of the claims process like denials.

Also, inquire where the staff is located: outsourcing to countries worldwide is common in medical billing. Outsourcing can reduce your total costs, but make sure the education, training, and English language standards are as high for the outsourced workers as they are for US staff to avoid any drop-off in service levels. Read more about offshore outsourcing.

Checking references

Ask the billing services for references to practices similar to yours in size and specialty. While you're sure to be referred to very satisfied customers, questions like these can help you determine how good a match the service is for your practice:

• How long have you been working with this provider? What duties are they handling for you?
• Overall, how satisfied are you with them as a billing provider?
• Have they complied with HIPAA requirements to your satisfaction?
• How have your collections changed since you started working with this provider?
• What percentage of your claims are accepted on the first submission? And overall?
• How effective are they at pursuing unpaid claims?
• What's the best thing about working this service?
• How do you get information to them? Is the process intuitive and efficient?
• Do your patients notice any difference in billing or collections?
• Does your staff feel like they can count on the provider to resolve problems?
• What was the biggest challenge about working with this company?
• Do you intend to stay with this service for the long run?