It is a known fact that a healthcare facility’s billing department can create or ruin revenues. Hence, as goes for other practices, podiatry billing too needs to be precisely billed and compensated for all its efforts. Sometimes, the billing is done in-house, but many a times, it becomes a necessity to outsource it due to various reasons such as overburdened staff, delayed A/Rs and the increasing number of denied claims creating a dip in revenues. In these circumstances, the solo practitioner or the podiatry facility needs to decide on outsourcing its billing services.
In which conditions should one outsource the billing requirements needs to be reviewed first before locating the best company for the outsourcing needs. A few indicators are:
1. Are you getting compensated lesser for your services?
2. Are your billers and coders not competent enough for complex procedures or you are not being able to find trained and experienced ones for podiatry? Or are there frauds or oversights occurring in the organization?
3. Where does your practice stand against the industry statistics on reimbursements and clean claims?
4. Is the medical billing and coding system efficient enough to handle insurance payers’ compliance’s and can meet the ever changing rules and regulations?
5. Are the monthly and yearly reports being difficult to be pulled from the available systems?
6. Would it be better to have fixed costs for your billing and coding needs? And would this lead to focused patient care than your tackling business issues?
7. Is your billing and coding being undertaken as per correct fee schedules and that none of the services are being missed out or under coded?
If most of these answers is yes, then it is time to outsource your billing and coding processes. But which are the areas that need to be identified and verified before deciding on the outsourcing company. Here’s a checklist:
1. Coding: Find out if the outsourcing companies’ processes are streamlined and if the coding processes are efficient, along with competent and experienced coders.
2. Appeal system: Question whether the appeals and the follow up system (on appeals) are in place. Also find out how soon is the claim processed; the time taken from receiving the patient visit details from the physician to the time taken when it reaches the insurance payer/patient for the reimbursements to be processed. Also, how does the outsourcing company obtain these encounters (fax/mail/scan)?
3. Reporting: Enquire about the monthly/yearly reporting system followed by the company. Also find out the flexibility of the reporting system, and which parameters can be filtered to gain the required information (e.g. charges, payments). Also, whether the kind of reports generated is easy to read. How easy is it for you to access the reports (online)?
4. Collections: Inquire about the collection practices and the procedures to be followed on accounts that need consideration. Ask about the processes in which your podiatry billing department will be informed of any queries posed by the insurance payer. In case of the absence of the billing professional, does somebody else take on the billing and collections’ process?
5. Software: Update yourself on the outsourcing company’s coding books/coding software used by them for being able to apply the latest codes while reimbursements. Also, how safely the backups are kept (e.g. electronic medical records).
6. Clients and operational hours: Find out as to how soon your queries will be addressed by them (time interval – within 24 hrs or so). Also find out the number and names of the clients whom the outsourcing agency deals with for podiatry billing.
7. Fees: Be clear about the set fees of the outsourcing company. Do they have startup fee to be paid only once, is it a monthly payment system or are the charges calculated as a percentage of the total charges billed or on actual reimbursements? Does it include stamps, cost of statements and stationery?
If you have a multi-specialty practice/center, first find out the efforts in terms of percentage that goes into podiatry billing or if it’s a single practice, then what percentage of the income goes into billing services. Check out three to four practices and always get references. Sign the contract on a yearly basis. If the outsourcing company offers an integrated service with web-based documentation, scheduling and billing and coding services, along with a team of experts, then rest assured, your revenue cycle management is in safe hands.