How to Find and Screen Medical Billing Companies Outsourcing to a reputable medical billing company has

quickly become a popular and efficient means of handling

medical billing needs for practices of many sizes and

disciplines. Medical billing companies are becoming

industry partners with a growing percentage of clinics,

especially those out of their first year of business. With In

Touch Billing, you are armed with a team of certified

medical billing and coding specialists as your partners

working to get you the most money from every claim.

Medical coding, billing, and receivables form a chain that

truly becomes the backbone of a practice, and screening

medical billing companies to find the right fit leaves a

practice owner open to any number of mistakes and

vulnerabilities. Now, more than ever, it is an absolute necessity to approach the screening process by

examining the fundamentals (some of which go easily overlooked) of outsourced medical billing best

practices.

Versatility Medical billing companies should have the flexibility to submit claims via various resources, depending on

the specific need of the practice. While most clinics will have no preference of one clearinghouse over

another, an outsourced medical billing company that has the ability to submit to more than one

clearinghouse is an indicator of experience in submission variances. At minimum, one of the

clearinghouse partners the medical billing company works with should coordinate with the clinic directly,

in tandem with billing team members, for enrollments purposes. In Touch Billing works with multiple

clearinghouse partners to provide the highest level of service at the lowest possible cost – getting you

faster results with decreased denials.

Additionally, the medical billing company should offer integration via medical coding and billing

components of practice management software. A streamlined work flow operates on integration, so your

EMR/EHR (which should be certified by the ONC), practice management software, and billing should all

flow together in one continuous cycle, allowing your staff to have direct access to what the billing team is

doing and allowing the clinical manager or owner to audit billing flow and correlate this with front desk and

clinical results. In Touch Billing integrates directly into In Touch EMR and In Touch Biller Pro, so you

know your documentation platform is certified by the Federal Office of the National Coordinator, and you

now your claims are being handled right away. Faster reimbursements and lower rejections, all able to be

audited in real-time.

For clinics operating in conjunction with or under the business umbrella of a hospital, the ability to handle

both CMS (HCFA) 1500 as well as UB-04 claims is an absolute must. This also applies to clinics or

practices looking to expand into institutional billing for any reason. In Touch Billing can do it all –

professional or institutional, we have the experience to submit to any payer in any format.

Click here to schedule your In Touch Billing discovery call.

Measuring Against Industry Standards

In order to know how a medical billing company will perform for you, it's important to know what the

general concept of "good performance" amounts to in the world of outsourced medical billing. These

concepts are called Industry Standards, and are the baseline for what is the average performance of a

nominally priced outsourced billing provider. The two most important Industry Standards to look at are

collections percentage and first pass rate.

The collections percentage is the amount the medical billing company charges a clinic, calculated as a

percentage of either the total amount they collect on the clinic's behalf or on the total amount billed out.

Avoid any medical billing company that charges based upon the total amount billed out. Collections

percentages should be based only on the amount collected by the company on behalf of the clinic. There

are two simple reasons for this:

• Clinics should not be responsible for paying a percentage on claims that may never be

reimbursed.

• Pressure should always be on the medical billing company to secure the highest reimbursement

possible in the shortest amount of time.

The easiest way to think of it is: the medical billing company should only be paid on a claim when the

clinic is paid on a claim. The Industry Standard for average collections percentage is currently 6% of

collections, depending on claim volume. Companies may also charge a monthly minimum for billing in an

effort to cover overhead in the event that the clinic has an unexpected period of lower claim volume. This

is a common practice, but be sure to do the math of monthly minimums. A common tactic of

unscrupulous companies is to advertise low percentages, but hide high monthly minimums in their

contracts. Monthly minimum charges should never be higher than what a clinic would reach during an

average billing cycle and should always be openly discussed in negotiations.

First pass rate is the Industry Standard for the success rate of claims being submitted to a payer, via a

clearinghouse, and being accepted and paid accordingly on the first attempt. Currently, the average first

pass rate fluctuates between 88% and 90%.

These two simple pieces of information can help in the screening of medical billing companies by

comparing where they stand against common Industry Standards. The best companies will have a

collection percentage lower than 6%, while maintaining a first pass rate above 90%.

In Touch Billing has an average first pass rate of 98.2% and an average collections percentage of 4%,

depending on claim volume. We maintain these standards of excellence all while staying at the forefront

of compliance and security. Schedule a call today to get your quote.

Security Technical terminology can make this aspect of screening for medical billing companies feel overwhelming

or convoluted, but knowing what to look for and what information to ask about can make or break your

compliance in era of ever-tightening regulations.

Medical billing companies should strictly comply with HIPAA, FDCPA, Patients Privacy Act and HITECH

regulatory standards. They should be ISO 27001 certified to ensure the highest level of data protection at

all times. The International Organization for Standardization (ISO) 27001 certification helps companies

establish effective data management systems. The medical billing company should also be ISO 9001

certified on the basis of continual improvement initiatives related to the transparency of data and increase

in quality of services.

An aspect of security sometimes overlooked is FTP. Before considering a medical billing company,

always ask if they have their own secure FTP servers.

In Touch Billing meets these regulatory mandates – and more. Plus, we have our own dedicated secure

FTP servers.

Expectations of Work Flow and Metrics Data Medical coding, billing, and receivables management are all data driven aspects that depend on proper

work flow. As such, knowing the specifics on how a practice's claims and AR will be handled is key.

Upon receipt of documentation and service data, the first and most obvious step is for the medical billing

company to check for standard coding issues. This happens faster and more efficiently when the

integration discussed in section one is in place, such as with In Touch EMR, In Touch Biller Pro, and In

Touch Billing. Once documentation is finalized, it should appear in your integrated practice management

and billing software that your staff has access to and that the billing team works out of directly. If this isn't

in place, the onus is on the practice to provide access to this information to the billing team.

As a general rule, claims should be created within 24 hours of receipt of service data and the claim

created, pre-scrubbed, and submitted within five days.

A practice that uses an ONC certified EMR such as In Touch EMR will already provide the billing

company with service data containing ICD-10 codes to the more specific level, correctly applied functional

limitation G-codes, background data on 8 minute rule calculations where applicable, and PQRS will

automatically be reported (In Touch EMR is also a PQRS registry, taking the reporting work out of

PQRS). If a practice is not utilizing an EMR platform that automates these processes, the medical billing

company should be checking each aspect of the claim data while performing other procedural checks,

such as for NPIs, payer identification numbers, claim specific patient demographics, etc.

When searching for a medical billing company, be sure their team includes an EDI specialist who will

analyze any rejected claims should they occur, correct the errors, and resubmit a clean claim.

Simultaneously, any errors received should be shared and filed with the billing team members

responsible for charge entry and any on-staff coding specialists to minimize re-occurrence of errors.

As practice owners or clinical managers compare medical billing companies and their work flow, ensuring

a payment posting team quickly (within 24 hours with In Touch Billing) reviews the EOB files received

through scans or ERAs through the clearing house should be another factor to consider. Before posting

payments, this team analyses and reconciles deposit slips, insurance check copies, patient payments,

etc., and calculates total payments received by batch with the amounts received from the payer.

Check to be sure that the contract between the practice and medical billing company includes the

services of a dedicated AR specialist. This specialist generates reports of claims which are unpaid for

more than 30/60/90 days and analyzes them. The AR specialist follows up with the payer with respect to

the pending claim status, analyses why the claims remain unpaid and takes appropriate action to get the

claim paid. No additional costs should be associated with this vital step, and In Touch Billing is proud to

include this as a general component of service.

If a practice has decided on a medical billing company integrated with practice management and EMR

software such In Touch Billing, reporting and metrics tracking easily becomes an advanced tactic capable

of populating any scalable metric entered into the system from intake to posting. This set up allows

practice owners and manager to trend referral sources, income based upon code, provider performance,

rejection and denials over time and based on cause, evaluation lineage, and more.

For companies or set ups that don't fully integrate all of these features, a 15 day and 30 day billing

summary should be provided alongside all weekly standard Accounts Receivable reports.

The medical billing company should also provide an option (not a mandate) to send patient statements on

behalf of the practice.

BONUS TIP: Avoid interaction between billing companies and patients. Once the statements are sent,

the patient should communicate with the practice in all matters, even those related to payments. The

patient experience is the responsibility of the clinical staff, and clinical culture should never rest upon

interaction with an outsourced billing team.

Knowing what to look for, what to expect, and the right questions to ask can take the complicated process

of finding and screening medical billing companies, and simplify it. Always remember that the medical

billing company should operate as your ally in the quest for full and prompt payment from insurance

companies. Ensure you're signing a contract with a company that will act as your partner, and know the

facts before ever signing.

Click here to schedule your In Touch Billing discovery call.