How to Know When Not to Hire a Billing Service
December 1, 2020

How do you know if you really have billing and RCM covered?  It's possible, and there are plenty of practices that have it all together.  Here's how to know if yours is one of them.

  1. You have no staffing issues and there is no concern you may lose a key employee.  Admittedly, everyone suffers the occasionally lost employee, but when that person is a seasoned medical billing pro, she may take a great deal of undocumented knowledge with her.  Which brings us to item number two...
  2. All of your medical billing and revenue cycle processes are fully documented and accessible for those who need them.  The documentation that came with your practice management software is fine for what it is, but it’s a far cry from what you'll need in an emergency.  For kicks sometime, sit down with your managers and have them walk you through the details of your processes.  You’ll be shocked at what it takes to get your claims paid and gain a fresh appreciation for your staff's expertise.
  3. You have no doubts about the efficacy of your billing efforts.  The fact is that no one will love your business like you do, and unless you're married to your billing manager, finding one that performs at the high level required to ensure your peace of mind is a rare thing.  If you have one of those, hold on tight and don’t let go.
  4. The work always gets done.   Submitting claims, posting payments, and sending patient statements is only a small part of the revenue cycle management picture.  Denials management, resolving clearinghouse issues, account follow-up, payor correspondence, credit balance and refunds processing, credentialing and EDI enrollments are all equally important for maintaining a high functioning billing office.
  5. All of credentialing and enrollments are in order.  This was mentioned in item four, but credentialing and enrollments really deserve mention of their own.  Credentialing can be extremely tedious, and the attention to detail required to stay on top of the countless payors, TPAs, and credentialing bodies, existing applications, CAQH re-attestations, and EFT and ERA enrollments can be a full time job in itself – and one that often needs more attention than it gets.
  6. Your system reports give you all the information you need.  As the proverb says, "Be sure to know the state of your flocks, and give careful attention to your herds."  Your EOM (end of month) and on-demand reports should provide the information you need for sound decision-making.  If they don't, you may be missing key data that can reveal systemic problems and provide warning signs about the future.