ebook: key factors when evaluating outsource medical billing

Download eBook:  Key Factors when Evaluating Outsource Medical Billing

Post on 27-May-2015



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  • 1. Key Factors whenEvaluatingOutsourceBilling Partners A CareSmart Billing eBook.

2. There are many circumstance that may Home Health Careresult in a medical provider, home health, or Hospice deciding to outsource theirhospice agency Physician or Medicaid billing. Aprivate, Medicare,new practice or agency may want to focuson the processes and care vs. billing at thelaunch of an agency. 3. A more established providers may be Home staff turnover or lack of qualifiedfrustrated by Health Care Hospice staff. Sometimes, anand reliable billing Physicianagency may look to outsource billing on ashort-term or emergency basis, to cover stafftransitions or an unexpected illness on theirbilling team. 4. Whatever the catalyst, the decision to Home Health Careoutsource billing is only the first in what shouldbe an extensive evaluation process of optionsHospiceavailable to agencies. This eBook discusses 7 PhysicianKey Factors that you should focus on as youbegin your search, narrow your choices, andultimately make a decision of a best fit billingcompany for your agency. 5. The 7 Factors Critical Information You Need to Make a Decision 6. #1 Define the NeedMany resources start their list focused on the billingcompany. Before turning your attention to your search, akey step is to evaluate your agencys specific needs.Taking the time to complete this step will eliminate hours,days, even weeks from your search process. You may betempted to say I just need someone to do the billing fromnow on, but by focusing on the specifics of what servicesyour agency needs, you can better identify thosecompanies that can meet them. 7. #1Sit down with the key members of your staff or a trustedassociate and map out the services you need.Some services that vary by billing company:Insurance Eligibility Accounts Receivable TrackingCodingHistorical Claims TrackingClaim SubmissionAuditsPPS MonitoringCredentialingDenial Management Follow up FunctionsPatient Accounting - Statements Transfer to Collection AgencyCustomized Reporting 8. #1Create a Needs guide using a document or spreadsheeteditor. A spreadsheet is ideal as it allows you to list theneeds of your agency in the first column and then trackthe services provided by the billing companies youresearch side by side: 9. Home Health Care Hospice Physician 10. #2Contact your state or national associations to getrecommendations of billing providers for your industry.As you get a list, conduct qualifying phone calls Years in business Number of employees Number of current clients Capacity to take on new clients 11. #2Note: Balance experience, years in business, experienceand number of current clients to what your needs are. Alarge national billing company may not provide thepersonalized service a new agency may require. Likewise,a well-respected regional company may not be a best fitfor a large multi-state home health organization. 12. #2Request key metrics: DSO Says sales outstanding Submission and follow-up delay metrics Billing cycle metricsAverage A/RReduction of payment delays 13. Home Health CareH O M E H E ALT H HospiceM E D I C AL P R O V I D E R PhysicianHOSPICE 14. #3When you evaluate a billing companys experience, youshould ask specific questions regarding their home healthand hospice billing experience. Experience with homehealth Medicare and Medicaid is critical for agencies thatsee these patients. 15. #3Key Questions to ask:How many years of experience for my specialty?What states have you successfully billed in (key forMedicaid)?What private payors do you have experience with?What type of practices or agencies do you haveexperience with (start-up, Medicare certified, privateonly, hospital, large franchise)? 16. #3It is also important to ask how the companys staff staysup to date with terminology, regulations, HIPAA and othercompliance issues.Lastly, with ICD-10 looming, it is critical to make sure thatnot only is the billing company training their staff on thechanges, but that the software and clearinghouse theyuse has been tested and passed for HIPAA 5010compliance. 17. Home Health Care Hospice Physician 18. #4Now that you have determined the billing company has theindustry specific experience, use the Needs spreadsheetyou created in Step #1 to identify which of the companiesyou are evaluating can address them.It is likely that different companies offer different levelsof service. By using the Needs sheet you and your teamcan see visually the top two or three companies that mostclosely align with your practice or agencys billing needs. 19. Home Health Care Hospice Physician 20. #5Technology compatibility is a key component whenselecting a billing partner. Some companies will work withyour current software, some require you to switchsoftware, others simply have you export your informationto them and they key it into their software. 21. #5If your practice or agency has software, and it fits yourneeds, it is important to find a company that will work withyour software. This allows you constant access to thefinancials. You can monitor youre A/R and address anyissues as they arise. 22. #5If your agency is currently paper based, discuss with eachof the companies the option for software for your agency.The billing company may have two or three vendors thatthey recommend from experience and client response.If the billing company includes software with their billingpackage, evaluate the software as vigorously as youevaluate the company. Ask if the software is included atno charge, or if there is an additional fee or increase inpercentage rate. 23. #5If your practice or agency is part of a hospital or largerorganization, you will need the ability to communicatebilling, receivables, and reporting information over yournetwork. Ask the billing company how they will facilitatethis. 24. Home Health Care Hospice Physician 25. #6There are usually three pricing models offered by billingcompanies: Per Patient Percentage Per ClaimEach model has its advantages and disadvantages, so it isimportant that you evaluate what best meets the needs ofyour practice or agency with regards to budget, businessmodels, and projected growth. 26. #6There are usually three pricing models offered by billingcompanies: Per Patient Percentage Per ClaimEach model has its advantages and disadvantages, so it isimportant that you evaluate what best meets the needs ofyour practice or agency with regards to budget, businessmodels, and projected growth. 27. #6Per Patient This fee-based model charges a fixed dollar rate per patient per month. This model can be more cost effective as it is not tied to the amount collected, but can also provide less incentive for follow-up on denied claims. With this model, forecasting billing as a budget item is easier as the cost is usually fixed. 28. #6Percentage With the percentage model, the billing company collects on the total collections. Many see this as a win-win model as the success of the billing company is directly tied to the successful billing for the agency. A drawback is that potentially, a billing company will focus only on big claims when it comes to denial management vs. the smaller claims. However, reputable companies work to recover all of a clients monies. 29. #6Per Claim Rate With this model, the billing company charges per claim for the submission. There is no incentive for service to follow up on claims. Denial management, collections, aging are additional charges. 30. Home Health Care Hospice Physician 31. #7The last focus is on the terms for service. Ask to see acopy of the Terms & Agreement once you have narrowedthe field.Things to evaluate:Upfront costs HIPAA ComplianceLength of contractConfidentialityRenewal terms BAA ComplianceAdditional Fees/Charges Support options 32. After focusing on these key areas, your Home Healthable to successfully agency should be CareHospiceidentify which home health billing companyPhysicianis a best fit for your agency.For more outsource billing information, sign up for the CareSmart Billing blog at:http://www.caresmartbilling.com/blog/