5 Mistakes to Avoid When Hiring a Medical Billing Service

Your healthcare practice holds a great deal of responsibility in providing quality care to your patients. Making the strategic decision to outsource your billing is supposed to make your practice run more effectively, not generate more stress and administrative oversight.

When you are interviewing service providers to take over the management of your claims submissions, you are, in effect handing over the keys to your inbound cash flow for the term of the contract. Many medical billing service providers claim to provide quality services at affordable rates, yet there are some warning signs to watch out for when you are evaluating service providers.

Here are five common mistakes medical practices often make that you’ll want to avoid before handing over your claims processing operations.

1. Don’t Get Blinded by Sizzle – Contract Based on the Quality of the “Steak”

Examine the performance metrics which the billing service provider is focused on. Do they demonstrate excellence in:

  • Clarity of billing terms
  • Successful claim payments
  • Volume of billings
  • Longevity in the business
  • Contracts with medical offices similar to your size/patient volume
  • High first submission processing rates

Statistics and performance claims are only as effective as how relevant they are to your business.

2. Does the Billing Service Provider Offer Value Added Services?

If the prospective healthcare billing company just sends out claims, and deals with whatever customer inquiries come back, are you truly getting value for your investment? Value for your investment is more important in the long run than lowest price.

Some services which can increase payments, and maintain your patient base include:

  • Patient insurance verification
  • Online self-service patient payment portals
  • Management of end-to-end billing to collection lifecycle including appeals
  • Claim processing reporting

3. Review the Contract Terms and Fine Print

Much like with the first point, getting carried away during the sales process can cause you to scan the terms and conditions of the billing services contract, and make you liable for low quality service for longer than you expected.

Carefully consider all of the deliverables, contract termination clauses and the length of time you are contracting for, before you authorize services. Better yet, have an attorney review the contract to point out any potentially problematic terms.

If the contract doesn’t contain any Service Level Agreement clauses, try to negotiate some in, be it to get a service cost reduction, or as an “escape clause” for contract termination.

4. Clarify Rules of Engagement

f you have signed off on your contract, and only have your Account Manager’s contact information, are they going to be responsible for any customer service escalation, claim inquiries and/or payment followups?

Before contracting the services of a medical claims processor, make sure it’s clear who you, and your patients should contact in the event of a dispute, service quality concern, or any unexpected service “anomalies”.

5. Check References and Customer Testimonials

As the old saying goes, if it seems too good to be true, it probably is. Don’t just take the billing service provider’s word about their services, ask to talk to/learn about the existing healthcare practices using their services now.

Customer testimonials with practice names are a good sign, and reference calls are ideal, if you have any question about the reliability of the health claims service provider.

Medical practice reimbursement services requires a wealth of experience, thorough claims documentation and an understanding of the increasing scrutiny over medical billing.

Before you gamble on a low-cost provider with aggressive sales tactics, consider how claims errors will impact your bottom line. Your practice is liable for the errors made by service providers you outsource to, and re-submitting rejected claims takes valuable time out of your day.


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