For many healthcare providers, the decision to outsource medical billing often hangs on two important factors – cost and specialty. Even though these are valid concerns, there is a lot more that should be considered when outsourcing.
Here’s a checklist that practices or hospitals need to consider when choosing to hire a third party:
- HIPAA compliance – it is very important to ensure that the vendor offers only HIPAA compliant services. To assess HIPAA compliance, take a look at the company’s current operations. Also, enquire with them about their staff education around protection of PHI. They need to have secure networks or else they will be held liable for a HIPAA breach. You will also have to ensure that the company isn’t using information from the records for any other purpose other than coding and billing.
- Staff availability – second factor on the checklist is the availability of well-trained staff to support the medical billing needs of your practice. This is needed for quick and error-free processing of claims. If there is enough staff, quick claims turnaround can be achieved. It is also necessary to know the number of clients the company is currently handling and the volume of cases they are typically working with.
- Access to reports – the vendor should generate progress reports based on your stipulations. This will be needed to track their performance. Make sure you are absolutely clear with your expectations when hiring a medical billing company. If you want a progress report every week, then tell them. Through progress reports, you will be able to retrieve a good amount of control over your practice functions. Pay attention to the dates and details on the reports.
- Coder certification – next on the checklist is coder certification in your specialty. Credentials denote that the coders have received specialized education and training in the selection and application of codes. If the team of coders doesn’t know your modifiers or outliers can how can you practice get paid? Besides certification, look for experience as well.
- Technological capabilities – it is not just important to ensure that the transmitted data will be safe. You must also check the vendor’s technological capabilities of working with your EHR/EMR system. Ask them for a demo of how they will have their IT system integrate with your system so that everything is easily accessible.