Any medical billing service worthy of consideration should perform an evaluation of your practice and current billing practices to customize a menu of services tailored to your specific needs. A one-size-fits-all approach is a red flag warning you that you’re likely to be charged for services you don’t need.

Look for a firm owned and managed by people with direct medical billing experience in an outsourced company. Outsourced medical billing is unique, complicated and encompasses more than most in-house billing functions.

Evaluating Servicers

Apples-to-apples comparison of medical billing providers can be tricky. Price and value are not always synonymous. Consider these variables:

• Look for stability and professionalism. How long has the server been in business? Is it a home-based business without staff? Check with the Better Business Bureau.
• Compare staff training, experience and turnover rates. Is staff certified in medical billing by a recognized association? What is the manager/staff/physician ratio?
• Ask specifics about technology. Software should be nationally recognized and up-to-date.
• Compare claim rejection and resubmission rates. The higher the rates, the longer it takes for you to get your reimbursement.
• Ask how often they send claims to payers. How often do they follow up on outstanding claims? Frequency matters to your revenue stream.
• How do they handle patient inquiries?
• Compare reporting measures, customization options and understandability. Do they provide recommendations for improvements or just reports?
• Access to patient account information should be provided.
• Ask about data protection, backup procedures and security.
• Compare pricing. Most billing services charge a percentage of monthly claims; percentages vary based on volume and size of claims. Watch out for billers that charge different rates for different third party payers. Isolate additional fees for add-on services.
• Is there anything that distinguishes a particular servicer from the rest?
• Do check references.
• If there’s a sign-on fee, ask what it covers. A billing company should not charge you thousands of dollars to be your servicer.

Staffing Concerns

One of the biggest problems in the medical billing services industry is insufficient staff. Every outstanding claim on a physician’s accounts receivable list should be called every month. Status must be checked and request for payment made. Claims may have to be re-filed. And yes, the squeaky wheel gets the grease.

You’ll want to know how many physicians each collector handles. How many claims is that each month – how many calls? How are collectors’ follow-up calls tracked and monitored? Are collectors stretched beyond what is reasonable? Failure to follow up on claims not only delays reimbursement; it can result in nonpayment after a certain time period has passed. Will the collector have time to make calls for your reimbursements?