Start-Up Services
Many of our clients outsource their billing office to a third party but not all of our clients have had a good experience with this. Unfortunately, many companies cut corners and hire workers (or don’t hire enough workers) who are uneducated in your specialty and ill equipped to handle the demands of your office. If you are one of those offices considering outsourcing, just select judiciously.
We used to own a billing company and listed below are the guidelines that we followed. We understand that there are numerous options out there for you and it would be easy to just select based on the billing service provider that can give you the best rate. This would be a mistake in most cases. Use the below information when evaluating your billing service provider and you will greatly reduce the risk of selecting the wrong vendor.
Outsourced Billing Guidelines
Operational Consistencies:
- Daily batches sent over through FTP split up by payments and encounters
- EMR clients will send all payments and any paper encounters from outpatient procedures
- Charge entry and coding of claims completed within 48 hours of receipt
- Claims scrubbed and submitted electronically within 48 hours of receipt
- Payments posted to patient accounts within 48 hours of receipt
- Denied claims posted with $0 payment and reason for denial
- ERAs posted by line item through system and verified by biller
- Statements mailed to patients daily through billing system
- Secondary claims daily dropped to paper through billing system
Weekly Reporting-all reports emailed to billing account manager:
- Denial report with claim number and denial code
- Patient collection report for all patients that have received three statements
- Monthly close by the 5th day of the following month
Coding:
- CCI edit software recommended to verify the correct modifiers and CPT codes
- Graduated audit scale used to determine coding efficiencies of office
- Auditing should focus on procedures and high dollar claims