A CareSmart Billing eBook.

Key Factors

when

Evaluating

Outsource

Billing Partners

Home Health Care

Hospice

Physician

There are many circumstance that may

result in a medical provider, home health, or

hospice agency deciding to outsource their

private, Medicare, or Medicaid billing. A

new practice or agency may want to focus

on the processes and care vs. billing at the

launch of an agency.

Home Health Care

Hospice

Physician

A more established providers may be

frustrated by staff turnover or lack of qualified

and reliable billing staff. Sometimes, an

agency may look to outsource billing on a

short-term or emergency basis, to cover staff

transitions or an unexpected illness on their

billing team.

Home Health Care

Hospice

Physician

Whatever the catalyst, the decision to

outsource billing is only the first in what should

be an extensive evaluation process of options

available to agencies. This eBook discusses 7

Key Factors that you should focus on as you

begin your search, narrow your choices, and

ultimately make a decision of a best fit billing

company for your agency.

The 7 Factors

Critical Information You Need to Make a Decision

#1 – Define the Need

Many resources start their list focused on the billing

company. Before turning your attention to your search, a

key step is to evaluate your agency’s specific needs.

Taking the time to complete this step will eliminate hours,

days, even weeks from your search process. You may be

tempted to say “I just need someone to do the billing from

now on,” but by focusing on the specifics of what services

your agency needs, you can better identify those

companies that can meet them.

#1

Sit down with the key members of your staff or a trusted

associate and map out the services you need.

Some services that vary by billing company:

Insurance Eligibility

Coding

Claim Submission

PPS Monitoring

Denial Management

Patient Accounting - Statements

Customized Reporting

Accounts Receivable Tracking

Historical Claims Tracking

Audits

Credentialing

Follow up Functions

Transfer to Collection Agency

#1

Create a “Needs” guide using a document or spreadsheet

editor. A spreadsheet is ideal as it allows you to list the

needs of your agency in the first column and then track

the services provided by the billing companies you

research side by side:

Home Health Care

Hospice

Physician

#2

Contact your state or national associations to get

recommendations 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

#2

Note: Balance experience, years in business, experience

and number of current clients to what your needs are. A

large national billing company may not provide the

personalized service a new agency may require. Likewise,

a well-respected regional company may not be a best fit

for a large multi-state home health organization.

#2

Request key metrics:

DSO – Says sales outstanding

Submission and follow-up delay metrics

Billing cycle metrics

Average A/R

Reduction of payment delays

Home Health Care

Hospice

Physician

HOME HEALTH

MEDICAL PROVIDER

HOSPICE

#3

When you evaluate a billing company’s experience, you

should ask specific questions regarding their home health

and hospice billing experience. Experience with home

health Medicare and Medicaid is critical for agencies that

see these patients.

#3

Key Questions to ask:

How many years of experience for my specialty?

What states have you successfully billed in (key for

Medicaid)?

What private payors do you have experience with?

What type of practices or agencies do you have

experience with (start-up, Medicare certified, private

only, hospital, large franchise)?

#3

It is also important to ask how the company’s staff stays

up to date with terminology, regulations, HIPAA and other

compliance issues.

Lastly, with ICD-10 looming, it is critical to make sure that

not only is the billing company training their staff on the

changes, but that the software and clearinghouse they

use has been tested and passed for HIPAA 5010

compliance.

Home Health Care

Hospice

Physician

#4

Now that you have determined the billing company has the

industry specific experience, use the “Needs” spreadsheet

you created in Step #1 to identify which of the companies

you are evaluating can address them.

It is likely that different companies offer different “levels”

of service. By using the “Needs” sheet you and your team

can see visually the top two or three companies that most

closely align with your practice or agency’s billing needs.

Home Health Care

Hospice

Physician

#5

Technology compatibility is a key component when

selecting a billing partner. Some companies will work with

your current software, some require you to switch

software, others simply have you export your information

to them and they key it into their software.

#5

If your practice or agency has software, and it fits your

needs, it is important to find a company that will work with

your software. This allows you constant access to the

financials. You can monitor you’re A/R and address any

issues as they arise.

#5

If your agency is currently paper based, discuss with each

of the companies the option for software for your agency.

The billing company may have two or three vendors that

they recommend from experience and client response.

If the billing company includes software with their billing

package, evaluate the software as vigorously as you

evaluate the company. Ask if the software is included at

no charge, or if there is an additional fee or increase in

percentage rate.

#5

If your practice or agency is part of a hospital or larger

organization, you will need the ability to communicate

billing, receivables, and reporting information over your

network. Ask the billing company how they will facilitate

this.

Home Health Care

Hospice

Physician

#6

There are usually three pricing models offered by billing

companies:

Per Patient

Percentage

Per Claim

Each model has its advantages and disadvantages, so it is

important that you evaluate what best meets the needs of

your practice or agency with regards to budget, business

models, and projected growth.

#6

There are usually three pricing models offered by billing

companies:

Per Patient

Percentage

Per Claim

Each model has its advantages and disadvantages, so it is

important that you evaluate what best meets the needs of

your practice or agency with regards to budget, business

models, and projected growth.

#6

Per 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.

#6 Percentage

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.

#6

Per 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.

Home Health Care

Hospice

Physician

#7

The last focus is on the terms for service. Ask to see a

copy of the Terms & Agreement once you have narrowed

the field.

Things to evaluate:

Upfront costs HIPAA Compliance

Length of contract Confidentiality

Renewal terms BAA Compliance

Additional Fees/Charges Support options

Home Health Care

Hospice

Physician

After focusing on these key areas, your

agency should be able to successfully

identify which home health billing company

is a best fit for your agency.

For more outsource billing information, sign up for the

CareSmart Billing blog at:

http://www.caresmartbilling.com/blog/