Medical Billing

10 Questions to Ask when Interviewing a Medical Billing Company

15 Oct 2016

Millin Associates is a leading provider of billing services and software for Health & Human Service agencies – OMH, OASAS, OPWDD, DOH, Health Homes, and OCFS providers. Millin’s state-of-the-art technology (MillinPro™) is used by over 150 agencies throughout NY State and nearly 50 agencies currently outsource the billing process to Millin as well. The MillinPro system can integrate with the EMR of your choice. Millin continues to play a pivotal role in the transition from Medicaid to Managed Care and assists providers and the State in navigating this complicated maze. For additional information about Millin Associates’ services and software please contact solutions@millinmedical.com or (516-374-4530).

Can we see a demonstration of the billing process, arrange a site visit and contact existing customers that are similar to our practice?

Due diligence is critical in assuring the billing service company can clearly communicate and demonstrate the process they will be implementing on your behalf. Interviewing current clients will confirm that the process they communicated and demonstrated is actually what the client’s experience is. Confirm that the client references are the same type of providers as you are since billing rules and regulations can vary and expertise in the specific type of billing you will contract for is critical. A site visit to the billing company is also recommended when possible.

Is there transparency into all aspects of the billing process being performed on your behalf?

Transparency is a vital aspect of the billing service relationship; it allows you to monitor the activity being performed on your behalf. Client access to the billing software should be a requirement so the client can monitor the process.

Describe how you reconcile between the EMR and the Billing Process?

Lost revenue can occur when proper monitoring of the interface between the documentation of services in the EMR is not reconciled to the Billing Process. The reconciliation should assure that all billable services that are signed off in the EMR have been staged in the billing software/process.

Can you describe your pre-billing claim review process?

Submission of clean claims can have dramatic impact on cash-flow. A rigorous review of claims before submission can eliminate rejections and denials, both of which take time to resolve ultimately impacting the cash flow of your practice. Key elements of this review should include eligibility verification, proper adherence to billing regulations based on the service provided, proper charge calculation (APG, fee schedule, etc.) and proper payer determination.

Are claim submission, validation and remittances processed electronically?

To assure efficiency and accuracy claims should be processed electronically via 837 claims submissions, 999/277CA batch/claim validations and 835 claim remittances. Manual posting takes additional time and is more error prone therefore causing additional review to resolve these issues.

Can you describe your follow up process around Denials, Open Claims and Proper Payment?

Assure that there are clear workflows that identify and address all issues that are identified on the claims. The workflows should also be sensitive to the age of the claim to assure that claims do not age out if not attended to in a timely manner.

What is the process to communicate and document issues identified by the billing team?

As the billing team identifies issues that cannot be addressed directly, there should be a mechanism to escalate or direct the issue back to your practice. Preferably the communication should be in writing from within the billing software. This prevents the need for spreadsheets, emails and voicemails to communicate the issue and avoid miscommunication.

Describe the process around coordination of benefits (i.e. crossover to secondary and tertiary payers)?

Assure there are appropriate workflows and triggers in the billing process to identify and process these crossovers.

Describe your policies around adherence to billing rules and regulations?

Adherence to all rules and regulations is critical in the relationship. HIPAA and HITECH rules should be clearly addressed in the Business Associates Agreement established with the billing company. Billing rules and regulations that are not followed correctly can result in payment pull-backs and penalties. These issues can also trigger further audits by Federal OIG and/or State OMIG agencies.

How is the service priced?

Pricing of the service is a key factor in selecting a billing company. Many billing companies charge a % of collections while some charge a per claim rate or flat monthly fee.

While it may seem that charging a % will incentivize the company to do a better job, in reality it dis-incentivizes them to follow up on low dollar claims. In addition, if you accept Medicaid plans in NY State, the regulations do not permit you to pay someone a % to perform the billing process. While it’s tempting to go with the cheapest available service, in most circumstances… you get what you pay for.


Marcel Handler

Chief Financial Officer

Millin Associates, LLC

516-374-4530 ext. 5910

516-374-8613

www.millinmedical.com


This article was also featured in our newsletter Best Practices Vol. 12