What to Look for in a Billing and Management Outsource Service

Selecting a third party billing company poses a number of challenges. It's important to set your priorities and decide on the services you will need. Once you have narrowed down your search, ask these questions.

Questions to Ask Third Party Billers

  • How accessible is your company? Can I easily reach an Account Manager or the owner if I have questions or concerns?
  • What is your average client size? (number of physicians, total charges per month)
  • How is success monitored? Days in A/R? Collection rate? % of A/R over 90?
  • Is the quality and quantity of staff performance monitored?
  • How does your organization inform staff of current state and federal rules, regulations, and guidelines?
  • What billing compliance policies and procedures do you use?
  • Have you ever had a claims review by a local or regional carrier?
  • How many clients do you serve? How many full-time employees support them?
  • What type of reports do you provide? What is the frequency and timeliness of them?
  • Which employees will be assigned to my account? How many years of experience do they have?
  • Do you conduct background checks on new and current employees?
  • What is your employee turnover rate?
  • Which employees are experienced in my group’s medical specialty?
  • Are your employees credentialed? Please explain.
  • Outline the specific tasks a collector performs.
  • Do you measure employee productivity? How?
  • Do you perform quality reviews of your employees’ work? How?
  • Do you provide management reports on a monthly basis? If yes, what do they reflect?
  • Do you have record retention and storage policies? If yes, please describe.
  • What are the security and access features to assure HIPAA confidentiality and compliance?
  • Do you provide electronic imaging? Which paperwork?
  • Do you process credit balances and refunds? If yes, please share a sample credit-balance report.
  • Do you follow state escheat laws for returning unclaimed payments?
  • What information technology system do you use? Is it proprietary? How up-to-date is the system?
  • Can the software be utilized as a complete practice management software in the physician’s office?
  • Are billing codes checked and updated frequently?
  • Does the company update their system with contract allowables?
  • What kind of backup system and security is in place for the computer system?
  • Will you demonstrate the billing system?
  • Does your information technology staff incorporate the most current required industry changes? How often do you make updates?
  • Do you have customer service guidelines? Can they be reviewed?
  • Can you address current health care issues that affect our practice, e.g. can you report diagnoses specified in Medicare’s Physician Quality Reporting Initiative?
  • Describe your firm’s financial health.
  • Please provide current and past client references.

Establish an understanding of current performance measure and the practice’s short and long-term goals. Knowledge of both sides will go a long way to building a successful long-term partnership.