Medical Billing Outsourcing - Top 5 things to consider

The function of submitting claims to insurance companies and receiving the remittances in the medical office’s bank account constitutes the primary role of billing companies. Medical Billing is the second most important aspect of the physician practice, the first being patient care, and billing can make or break a practice. Doctors take the decision to outsource their medical billing to billing companies with a little bit of trepidation and some reluctance.

It is beneficial to a doctor to outsource the billing function as this activity is typically not the core competence of the doctor and the billing activity has become complicated and requires diligent folks to give their undivided attention. The outsourced billing companies have also gained tremendous expertise in the area and work hard to deliver the best results for the practice. In an ideal case, the two form a win-win relationship and help bring the best results for the all important patient (customer) at a low price point.

Selecting the billing company to partner with becomes a critical decision for the doctor practice. It would be good to keep the following points in mind during the selection -

1. Process

2. Service Portfolio

3. References

4. People

5. Intangibles

1. Process

Does the billing company have a well-defined process for delivery? What are the artifacts available? How does escalation work? Do they have clear lines of responsibility? What are the SLAs? Are there safeguards for poor performance and termination plans?

2. Service Portfolio

What services does the billing company offer? Does it include a broad range across multiple functional areas or do they have deep knowledge in a narrow vertical? Can they offer other related services?

3. References

Who are their customers? Can you talk to a current customer in your functional area to gain insight on the current delivery processes of the company? Are customers truly happy or satisfied with the billing company? Does the customer size match with your size?

4. People

Do you trust the folks running the company? Do you have enough information on the top management people? What kind of pedigree and experience do the people in the billing company have?

5. Intangibles

Do you feel confident about the execution plan? Can you visualize a positive and growing partnership with the billing company? Are you fearful? Are you a micro-manager and would you require hourly and daily reports or weekly and monthly reports?

When you answer all of the above questions honestly, you will be able to form a pretty good idea about the overall partner you are looking for. There are many gray areas and writing your questions, concerns and thoughts would present a good opportunity for further discussion and resolution.

What would be the answers to the above questions and how does that influence my decision. That would be in another post.