Medical practices are caught between declining reimbursement and increasing costs due to more complex regulations, higher employee costs, and the need for more sophisticated technology. Consequently, many practices are contemplating hiring a new billing partner, either for the first time or to replace an existing provider.
Partnering with the right medical billing company is crucial for the financial health of your practice. A reliable and efficient billing partner can significantly impact your revenue cycle, enhance overall practice management, and improve patient satisfaction.
Here are six key factors to consider when evaluating a medical billing partner:
1. Performance vs. Price
One of the first considerations is striking the right balance between performance and cost. While cost is a significant factor, evaluating the value you receive in return is equally important. A medical billing partner offering a competitive pricing structure without compromising performance can be a valuable asset to your practice.
Price is an easier variable to compare than those associated with performance. However, a lower price might indicate a company with less investment in technology, training, and repeatable processes. The lower price may also reflect a company with lower service levels, meaning they may not be responsive to your questions or needs.
Therefore, “Company A” collecting three, five, or ten percent more than “Company B”, may not mean “Company B” is the right choice. With better service and processes may come better returns ultimately making “Company A” the best billing partner. Pricing and performance differences of this magnitude are more common than not.
2. Reporting & Dashboards
The billing process generates data and information representing the practice’s financial and operational lifeblood. Therefore, it is essential to have complete access to all information at any time.
Today’s leading companies offer their clients robust advanced analytical reporting and “dashboards” showing practice performance at a glance, plus the ability to “drill down” into details as needed. Furthermore, the practice data should be easily accessible through a web-based portal with access and availability anytime and anywhere.
Transparent and insightful reporting is the cornerstone of effective medical billing. Assess the reporting capabilities of your potential partner, including the clarity and depth of information provided. A robust reporting system and intuitive dashboards empower you with real-time insights into your practice’s financial health, helping you make informed decisions.
3. Technology
The technology to operate an effective billing company has become exceedingly complex over the past several years. Ever-changing regulations, the proliferation of commercial plans, and the significant increases in patient responsibility are only a few of the drivers.
Ensure that your medical billing partner embraces cutting-edge technology to optimize billing processes. Some crucial factors to consider are:
- Compatibility with your existing systems
- Seamless integration
- Commitment to staying abreast of technological advancements
A technologically adept partner can streamline operations, reducing errors and enhancing efficiency.
Billing systems must be programmed to edit incoming data to create clean claims and efficiently file claims with all major insurance carriers. But this is only the tip of the iceberg.
Here are a few important factors to ask about:
- What is the coding workflow? Is it dependent on paper, or is it electronic? Typical turnaround time?
- How quickly are industry changes incorporated? (e.g., the Covid changes in 2020)
- How many interfaces are supported? i.e. EMRs, ADT, RIS, PACS, etc.
- Exception processes when unexpected changes occur?
- Are custom interfaces supported?
- What automation is in place to minimize denials, underpayments, etc.?
- How are patient payments facilitated?
- What privacy and security procedures are in place? Exactly how is PHI protected?
- How is implementation handled to avoid errors and payment delays?
4. Industry Experience
When evaluating a medical billing partner, prioritize those with a wealth of industry experience. A company that has been successfully navigating the complexities of medical billing for an extended period will likely have a deep understanding of the unique challenges and nuances within the healthcare sector. Look for a partner with a proven track record of working with practices like yours.
Learning the background of the companies you are evaluating will determine if their claims match real-world experience. Knowing how long the company has been in business and their experience in your specialty is a start. If you are looking for a new billing company, create a short list of companies, ask for references, and call them.
Ask about collections, A/R results, service, and reporting. Plus, any other items of particular importance to your practice.
5. Compliance & Security
In the eyes of federal and state regulations, regulatory compliance is ultimately the practice’s responsibility. However, a professional billing company with a robust compliance plan is a huge asset. Some companies even offer compliance training and other compliance services to their clients.
Compliance with healthcare regulations and robust security measures are non-negotiable. Ensure your potential partner is well-versed in the latest compliance standards, particularly HIPAA regulations. A commitment to data security, with solid encryption and access controls, is essential to protect the confidentiality and integrity of patient information.
A billing company with a strong compliance focus will help inform your practice of changes in industry regulations and, if your practice requires it, help deal with payor audits. Best of all, a company with a solid compliance focus means that audits and other payor reviews pose little or no risk to the practice.
6. Customization & Scalability
Recognizing the uniqueness of each medical practice, a reputable billing partner should offer customizable solutions. Assess their ability to tailor their services to your specific needs, ensuring that the partnership aligns with the size and specialty of your practice.
Additionally, consider scalability – your partner should be equipped to grow alongside your practice, accommodating its evolving needs. Regarding scalability, evaluate the partner’s capacity to grow, technological infrastructure, potential future financial arrangements, and support for new services.
Customization and scalability are integral components of a successful medical billing partnership. A billing partner that offers tailored solutions and can seamlessly adapt to your practice’s changing needs and growth trajectory is more likely to contribute to your healthcare organization’s long-term success and financial health.
At Health Prime, we can help!
If you are looking for a medical billing partner to help you achieve your goals, Health Prime can help!
Choosing Health Prime as your medical billing partner is an investment in a collaborative and strategic alliance. With a proven track record, unwavering commitment to excellence, and a dedication to the success of your practice, Health Prime emerges as the ideal partner for navigating the complexities of medical billing.
For more information on choosing the right medical billing partner for your practice, email us at [email protected]. Our team will schedule a meeting to discuss how we can optimize your workflows by cutting costs and saving you time!
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