The candle of learning burns through curiosity; it drives us, excites us, and breaks the monotony of otherwise mundane life. Interest manifests as questions and leads us towards a better understanding of a subject, improves relationships, and helps us set up the right expectations.

You are here, trying to figure out the right approach to get one step closer to identifying the right Medical Billing Vendor for your practice; let’s try to help you by sharing what we think are the 10 important questions you should ask your service provider during your discussions. 

  1. What kind of experience do you have in our Speciality?
    Billing companies work with multiple providers, often working on different specialties. It’s good to know whether they have experience of your Speciality as that’s required for them to understand the unique challenges you face on a day-to-day basis. Having prior experience would also mean that they can use it to implement effective strategies and improve your bottom line. 
  2. Do you have any experience in our state or any clients you are working with at the moment?
    Billing regulations and guidelines change for different payers in different states, so find a billing partner who is already aware of your state billing guidelines and knows the type of LCD & NCD rules would be less prone to make those errors, resulting in higher clean claim ratio, reduced turnaround time and faster reimbursements.
  3. Do you use your own billing software, or are you software agnostic?
    Medical billing vendors with large teams sometimes use their proprietary software or use the software they are good at. This means integrating their billing software with your EMR and migrating patient data to create claims. You may not have full access to this new system which means you now have limited transparency and control – Are you okay with that? It’s best to inquire about this upfront before moving on with the discussion, as this could be a deal-breaker.
  4. What’s your plan of action for this particular situation in our Billing Cycle?
    You may have diagnosed the issues with your existing revenue cycle team, or maybe you are just looking to improve the overall performance. It’s best to come up with problem statements in your billing cycle, even if they are fictitious. It lets you dig a little deeper into the knowledge base of potential vendors. They’ll be glad to share their experiences in similar situations or probably cook up a solution on the spot – either way, you will know their ability to work under pressure and think on their feet. 
  5. Where are you located?
    RCM vendors range from independent contractors to multinational corporations, and both have their pros and cons. The flow of information, comprehension, and execution have to be quick to deal with changing billing guidelines proactively. Ask your billing vendors about the locations of their delivery centers, what all tasks are assigned to which teams, and what measures are taken to keep them in sync with changing regulations, payer rules, industry standards, how they maintain HIPAA compliance, etc.
  6. How do you accept payment for your services?
    Billing service vendors operate under multiple engagement models and accept payments through checks, wire transfers, or other web-based payment transfer platforms. However, some banks charge significantly higher for wire transfers than others, so it’s best to confirm the preferred payment model and check with your banks to see how much additional cost it creates and try to choose the most convenient payment model that works for everyone.
  7. How could you help us become a better practice?
    Billing vendors can leverage their experience and extend as consultants who focus on your revenue cycle and impact over significant areas of practice management. You’ll be surprised to discover what is possible through an experienced team committed to its clients, so always ask about their holistic approach to make you a better practice.
  8. What kind of security measures do you have to protect the integrity?
    Integrity is a virtue everyone possesses, and its intensity depends upon a moral compass. While you can not see through the individuals working in an organization, security measures help immensely provide a greater degree of protection under the foundational work mandated by HIPAA guidelines. Additionally, a robust technological infrastructure further adds a layer of protection and can significantly impact disaster recovery management and data breaches.
  9. What is the term of your services, contract obligations, and exit policies?
    You should cover all your bases while outsourcing your practice’s RCM, which consists of being aware of any limitation of liability clause, various terms of agreements, responsibilities, and duties on your end, and the contract’s validity period.
    Revenue improvement progress isn’t always linear, and it largely depends on the shape of the account at the time of onboarding, factors such as your current average AR days, how much is your pending Old AR requires lots of efforts from the billing vendor to get it in good shape. Thus the progress may be slow and likely billing company wants to offer only long term binding contract for three to five years. It’s best to check with your service provider whether they offer an annual contracting option. Also make note of conditions and penalties if you want to exit before the contract period. Long term contracts may also come at discounted pricing so that’s also something you can consider if you are consistently getting satisfactory performance month after month.
  10. Are you comfortable sharing direct client references?
    A legitimate RCM vendor with satisfied clients would rather encourage you to talk to their clients as that is the direct reflection of their confidence in their performance. If they are hesitant to share active client references or unable to produce any kind of reference, then that’s a red flag and shouldn’t be taken lightly.