Categories: PMG Insights Blog
January 18, 2019
In past posts, we explored the pros and cons of outsourcing your center’s revenue cycle/ billing functions. If you have decided to consider outside vendors you must be sure that they are able to handle the job and improve collections at your CHC. Since most revenue cycle/ billing companies don’t tell you they plan on doing a bad job, it’s really up to you to determine who will make the best partner. It may seem like you will get the most value by selecting the least expensive vendor, we say, “buyer beware, you often get exactly what you pay for.” In order to help you make the best choice possible, we have created this list of questions you must ask any vendors you are considering.
Do you have CHC experience?
CHC billing is complex and differs greatly from billing in the public sector. It is important that your vendor has a grasp on things that make CHC billing unique (e.g. sliding fee scales, cost-based reimbursement, encounter rates, wrap payments, PPS Medicare reimbursement, etc.)
What is your experience in this state?
Medicaid and third-party payers vary from state to state, as do their regulations and billing requirements. Check with the vendor to see if they have experience in your state and that anyone assigned to your account will be familiar with the state protocols. A good vendor will be able to produce CHC references from the state your center is in. If you found a vendor you love but they have not worked in your state, all is not lost, ask them what the learning curve is and how they plan to overcome that without affecting revenue at your center.
What service lines have you billed for?
Just as important as CHC and state-specific experience is knowledge of your CHC’s particular service offerings. If you offer pharmacy or dentistry make sure the vendor has worked those specialties before. Don’t let a vendor learn to bill for a new service line on your dime. Make sure they are prepared to hit the ground running.
Do you have a HIPAA compliance plan in place?
Protecting patient PHI should be a top priority for any revenue cycle vendor. You should be able to confirm that there is a HIPAA compliance plan in place and of course the vendor should be ready and willing to sign a Business Associate Agreement detailing the safeguards that will be in place.
Do you work in our current PM system?
If you have an established PM system in place you will want to ensure that the vendor you select is familiar with that system, again, learning on your time is not an ideal situation. Be wary of anyone who tries to convince you that if you know one system you know them all. Also, many PM system vendors offer revenue cycle/ billing services as well. If you contract with them be sure to determine if you will you need to switch to their PM systems.
What does the onboarding/ transition process look like?
The process of moving to a new revenue cycle/ billing vendor is complex and if it not well executed it can negatively affect your cash flow. The vendor you choose should have a clearly outlined transition plan with specific indications of both team’s responsibilities and assigned due dates for all steps.
What reporting do you offer?
Find out how each vendor measures their success and how they will communicate that with CHC staff. Be sure they are consistently tracking revenue cycle key performance indicators such as days in accounts receivable, and denials rates by payer/ reason. Find out what reports you will receive, how they will be presented, and how frequently. Ideally, the vendor will review these reports with staff and leadership and work with you to create a plan to correct the cause of any claims denials.
Do you offer staff training?
If you struggle to keep providers and other staff adequately trained in billing and coding matters, you may want to look for a vendor that offers this service. Be sure to find out if there are any additional costs and who is responsible for creating and administering the training.
How do you handle self-pay collections?
You may want your revenue cycle vendor to take over some or all of your self-pay collections process. If so you will want to find out their policies for collections. Some firms send out a set number of collection notices and that is it, others take a more aggressive approach to collect payment. Be sure the vendor handles self-pay in a way that reflects your CHC’s policies on this matter.
Successful revenue/ billing relationships come from finding the partner that is the right fit for your CHC. Be diligent in making your selections! Don’t be afraid to push for answers, examples, references etc. to ensure that they can get the job done. If you are thorough in collecting this information from a variety of vendors, only then can you make an accurate assessment of your options and make the choice that will bring you great results.