Once upon a time, in the late eighties, a few “How to make money” magazines espoused medical billing as a great cottage industry. Unfortunately, that is exactly the perception many physicians have of the industry today. I guess, rightly so, because there are still a number of mom and pop medical billing operations out there being run from kitchen tables or garages.
As a doctor you run a professional business and you want to know that your partners operate at that same professional level. Old perceptions of the medical billing industry leave an impression that is out of sync with today’s reality of most professional medical billing companies.
The entire health care landscape has changed dramatically since the eighties and medical billing has become more than simply a data-entry or IT function that could be handled by a cottage operation. Every aspect has become more complex and sophisticated. New software technology, 5010 and ICD-10 compliance, patient prequalification and patient A/R are a few of the variables of medical billing that can cloud the true objective of medical billing companies. That objective is, of course, increasing profitability for the medical practice. The issue becomes even cloudier when you consider the number of web based articles and blogs advising “How to pick a medical billing partner” – hopefully this one will clear the smoke.
Generally, one of the last steps (if it is included at all) in the ubiquitous “How to” blogs advises asking the prospective billing partner, “Are you willing to work with my practice as opposed to shoehorning it into a pre-established set of process protocols?”
Shouldn’t that be the first question you consider?
From a simply pragmatic point of view don’t you want to know that a medical billing company can devote the time and resources to working with your practice? All the technology, know-how and procedures in the world aren’t going to make any difference if your medical billing partner doesn’t understand how to communicate with you, your staff, your patients and your insurance carriers.
A quick look at any medical billing company’s web site should help you eliminate the marginal players from the professional A-players. This will only take a few minutes and you’ll want to check:
- Certification of coders and billers on staff
- Professional affiliations (HBMA, MGMA, etc.)
- Company’s history and time in business
- Management – have they successfully run a business?
- Support and training offerings
- Do they have a dedicated account specialist who will learn your business?
- Client recommendations and testimonials
- Prequalification and patient A/R services
- Technology, 5010 compliance and ICD-10 readiness
- Location – can they meet with you on a day’s notice?
If the answer to any of these is negative, keep looking – your profitability is at stake.
At this point let me interject that I own CRT Medical Systems (a medical billing company) and I welcome any physician to hold CRT to the criteria I recommend above.
Once you have culled prospective partners by the criteria above, the key issue comes down to whether a prospective company will make the time to communicate and establish a great relationship with your practice? Or are they looking to sign you up to an automated system providing the minimal face-to-face support?
As a doctor you have so many demands on your time that it is almost impossible to keep up. Those demands are focused on practicing medicine and compliance, not running a business or the more intricate aspects of billing codes and claims submission. Yet, inherent in your practice are the needs of your billing department. Most of the time, coders and billers left by themselves trying to keep up with the workload and the reams of errata sheets sent out by carriers on a monthly basis are simply overwhelmed.
Finally, you are fending for yourself in the world of business. Shouldn’t you have a support system that knows how to run a business profitably?
That’s why the conversation with your prospective medical billing partners is so important.
Are they willing to help support and train your staff? Are they dedicated to staying informed on your behalf to help your staff operate more efficiently and effectively? Most importantly, can a prospective billing partner articulate how all of their services work in a holistic revenue cycle management system to ensure that your practice profitability is sustainable and your business healthy?