Outsourcing your billing activities makes sense for many medical practices, but finding the right billing service can be time consuming and hit and miss. Here are some essential questions to ask the companies you’re considering.

How long have you been working in this field and how many years of experience do your billers have? As you know, medical billing is complex and about to get more so, thanks to ICD-10 adoption. Experts in this field tell us there’s no substitute for experience, not even certification. There’s no harm in having certified billers, of course, but experience and common sense are what counts. A majority of claims are straightforward; but the rest require understanding the physician’s coding habits and billing accordingly. Although a great coder can be successful with any specialty, if you can find a company with billers experienced in your specialty, it should weigh heavily in your decision.


1.How HIPAA compliant are you? Simply getting a “yes, we’re HIPAA compliant” is not enough. Experts know that no practice or business is 100% HIPAA compliant; there’s always a continuum when it comes to compliance. That is why every healthcare provider or service is required to do an initial assessment, designate a compliance officer, designate a HIPAA security officer, and do ongoing periodic assessments, and then record compliance progress. No physician wants claims and patient data being handled by a novice. Ask specific questions about the company’s business associate agreements, email security, fax security, data security, document destruction, and equipment destruction (those computer hard drives may still have your patients’ PHI on them!). Most importantly, you should never outsource your billing to any overseas company. Overseas companies are NOT governed by HIPAA and any BAA signed by them is only worth the paper they are written on. There are a lot of billing companies out there that send your claims and patients information overseas to third parties because they pay pennies on the dollar to have you claims process. Make sure in your contract is states that all work is performed in the US at the billing company’s office.


2. What types of reports will I receive? Find out everything you can about the types of reports you’ll be getting and their frequency. Ask to see a sample of daily, monthly and quarterly reports to determine if they’ll work for your operation. Transparency is the key. Some medical billing services will offer you a username and password so you can log into the system remotely and run practice management and financial reports at your convenience. Some billing systems can produce special reports, or can adjust existing reports to suit—others will not. Now is the time to establish a comprehensive understanding of what you and your accountant will need by way of financial reports and make sure they’ll be available.


3. How willing are you to adjust to my processes? You have systems in place, and although you should not be adamantly against all change, neither should you have to entirely revamp for your medical biller.


4. Will your operation alert me about contract issues? Not all billing companies provide this service, and you probably want one that does. You want to know if one of your payers is reimbursing at 75% when you’re contracted at 120%, right?


5. What happens when the people on my account go on vacation or get sick? Make sure you’ll receive the same level of service every day, even if the people who usually work on your account are out. Ask if the billing company constraints employees and guarantees consistent service levels.


6. Which local, state and national associations are you affiliated with? You want a billing company that stays informed about regulatory and industry changes.


7. Who can I call for references? Just as you would with a new hire, take the time to call each company’s references, asking how long they’ve worked with the biller and what their experience has been.


Finally, of course, you must ask about cost. The important thing is to ensure you’re comparing apples to apples. If a company’s fees are low, make certain they provide everything the higher priced companies do. Here are some examples of services often skimped on by less expensive companies:


– Sending out patient statements in a timely fashion

– Following up on low-ticket claims

– Working accounts receivable (what percentage of their bills are presently over 90 days?)

– Following up on denied claims (do these get worked regularly or shunted into a pile until there’s a slow period?)


Being proactive about pursuing incomplete information sent by the provider.

With the answers to these questions in hand, you’ll be more than ready to choose the best medical billing company for your practice.

One Response to 8 Key Questions to Ask Before Hiring a Medical Billing Company

  • That’s a great tip to ask about references that a medical billing company has. Our mother has a lot of health issues, so she will be needing a good medical billing service. I hope we can find the right one that has some good references for us.

Leave a Comment