Facilities and practices like yours want to maximize productivity, enhance patient services, reduce operational costs and decrease administrative burdens. When considering an outsourced billing partner, however, there are some important things to consider.
In this post, we share the top nine questions you should ask before choosing a behavioral health billing company.
#1: Does the company you are considering specialize in behavioral healthcare billing?
A quick Google search for “medical billing company” returns more than 200 million results. That means you have many to choose from, but one size does not fit all. Behavioral health billing is generally more complicated than medical billing. Individual services can have fractional billing based on length of service and provider credentials, for example.
If you choose a company that has little experience with behavioral health billing, you will likely pay the price for them to learn the tricks of the trade.
Behavioral health billing companies with multiple clients in multiple states can help you spot changing trends in insurance billing practices and policies. And since insurance companies often contract with other insurance companies to manage behavioral health benefits, a specialized billing company is more likely to be tapped into the latest technology for submitting claims, concurrent reviews, and denial appeals. These things increase efficiency and decrease the time it takes for you to receive your money.
#2: Does the company support the entire revenue cycle from Verification of Benefits to Reporting?
When a patient admits to your facility or practice, there is a complex chain of events that occur to provide that patient with proper care and also for you to get paid. The billing part of that chain of events includes verifying that the patient has the ability to pay for your services. For insurance, it’s critically important to know whether:
- The insurance plan is active;
- Your services are covered by the plan;
- How much the patient must pay for co-insurance or co-payment; and
- How to file claims.
After you’ve provided services, there must be an efficient and error-proof method for submitting claims to insurance for payment.
In some cases, especially for higher levels of care, the patient’s insurance company will require ongoing utilization review of services provided. This requires a Master’s-level clinician who is familiar with the patient’s case to communicate with the insurance company’s reviewer to justify continued care. If you choose to do this yourself, these calls can take hours of your valuable time.
Appealing denied claims also involves a special art and science to succeed. When a billing company submits hundreds of appeals each year for multiple facilities and providers, they can identify trends in what works and what doesn’t. This increases their chances of overturning a denial.
Can your prospective billing company submit invoices for payment to your patients? Can they overcome the challenges of electronic payments from the dozens of different insurance companies you may work with?
And, finally, does your potential new billing partner have a reporting process that allows you to understand:
- How many claims are submitted and paid?
- How many claims are outstanding?
- Are denials increasing or decreasing?
- How long does it take for a claim to be paid?
This information can help you increase the profitability of your facility or practice and ultimately provide a higher quality of care to your patients.
When your third-party biller can take care of each step in the process, you should expect higher claim acceptance rates, lower amounts of confusion and a smoother operation.
#3: How accessible is the team?
As we all know, problems can pop up at the most inconvenient time. It’s important to know whether your billing team can be reached and respond to problems when they occur. What is their policy and process for communicating? Do they prefer an email, phone call or use a chat app? How quickly can the team begin working on your problem? Is there a single point of contact for your account?
#4: How does the company comply with HIPAA and provide data security?
In this area, your billing company can completely sink your business if they don’t comply with HIPAA regulations and work hard to protect patient information. Therefore, it’s important to know:
- What billing software they use and whether it is HIPAA compliant,
- What record policies they have at their office(s),
- How records are handled in the event of an emergency when staff must work remotely, and
- Whether they share in the legal and financial burden of a compliance violation.
#5: How much does it cost and what are the billing terms and conditions?
At the very heart of your decision to use an outsourced billing company is a desire to increase revenue and decrease costs. Here it is important to fully understand how the third-party billing company gets paid. Is it a percentage of the amount billed? Or of the amount collected? The difference between these two methods can be large.
Generally, we believe the billing company should share in the risk by charging a percentage of the amount collected. That motivates the billing company to make sure claims are submitted quickly with no errors. It also increases the chances they will fight for denials to be overturned since their success is tied to yours.
Ideally, your billing company should pay for themselves by improving your revenue and decreasing the amount of time and energy you put into this part of your business.
#6: What is the company’s contingency plan and strategy for emergencies?
Hurricanes and more recently the COVID-19 pandemic have taught many facilities how quickly business systems can be interrupted. It is fair to ask your prospective billing company how they manage the risk of disruption because your ability to continue providing care depends on uninterrupted revenues.
Are they able to work remotely when needed? Is data stored in a safe location and backed-up in case of computer failures? Can they overcome staffing shortages in case of pandemic sickness? Does the company have an executive succession plan?
A few short years ago, these questions may have seemed awkward. But during these chaotic times, you simply have to know the answers to these questions.
#7: Is the billing and utilization review team certified and trained?
Medical and behavioral health billing is a skill that requires education, experience and ongoing professional education. Does your billing company employ college-educated or AAPC-certified coders? Unfortunately, there is no specialty certification available for behavioral health coding at this time; however, organizations like AAPC do offer Behavioral Health Coding Courses. Have any of the billing company’s staff completed this training?
When your prospective third-party biller hires certified coders or those who have completed specialized training, this signals they value this professional skill and prefer to hire people who take the job seriously.
Is the billing company you are considering committed to ongoing professional education for its billing, utilization review and auditing team? If so, what kind of training do they provide and how often?
#8: How is financial data reported?
Financial information and status of claims reporting can make a really big difference in how efficiently you can run your business. For some of us, accounting and business management is not your first love. In that case, you need reports that make sense to you and help you see trends and problems early. For those who are highly trained in accounting and business management, you need reports that mesh well with your current business systems.
Ask your prospective billing company for sample reports and downloads. Use these samples to consider how your workflow might change and test downloads to ensure they mesh with your current systems. By doing this you may learn how well your prospective billing partner understands behavioral health as a business and how easy it will be to transition to the new billing system.
#9: How do we end the contract if the relationship isn’t going well?
Although we’d love to believe things work out well all the time, there are times when it just doesn’t. Before you commit to a relationship with this much at stake, how can the relationship end gracefully if needed? What are the contract cancellation terms? What are the key performance indicators you will use to determine whether your relationship is successful?
Bring it all together
Choosing to work with a third-party biller for the first time or switching from one biller to another is a complex decision with significant potential risks and benefits. We believe it is important to make a fully informed decision before you choose.
If you are actively seeking a new third-party billing company for your behavioral health facility or practice, take our 9-question survey to find out how your current billing company scores.
The Substance Solutions team is happy to answer questions and help you learn more about choosing a behavioral health billing provider. Give us a call at (954) 572-2643 or email us at Autumn@SubstanceSolutions.com.
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The Substance Solutions team is happy to answer questions and help you learn more about choosing a behavioral health billing provider.