So you are considering outsourcing your medical billing role. You have a good sense of what to do: review a few companies, get cost quotes, select the best one, onboard the new service. That’s all, right?

But where to start. Physicians and practice managers who are tasked with choosing a new 3rd party service will soon be presented with a dizzying array of benefits and features from different vendors.

  • Years of experience in the Medical Billing industry.
  • Physical location of the specialists – are the reps close to your office, for occasional in-person visits.
  • Training and expertise of the medical billing staff.
  • How HIPAA compliant is the company – Are they willing to review / agree to our business associates agreement?
  • How does the appeals process work – Some medical billing companies do not do appeals or follow-up on appeals.
  • What kind of coding software do they use – Confirm this software is compatible with your other in-house software and is tailored for your specific practice area.
  • Integration with your accounting software and reporting – How often will they report billing results (daily, weekly, monthly, etc)? What will the reports contain?
  • Reconciling against contracts – Does the biller compare payments against contracts, e.g. contracted to pay at 100% but payers are reimbursing at 85%.
  • Coverage when billers are out sick / on vacation – What are your backup procedures for staffing?
  • Associations you belong to / conferences you attend / training for reps – How do they stay on top of industry changes and regulatory.
  • What are the collections practices and procedures – do you do soft collections? How do they alert you when an account needs special attention?
  • Hours of operation – when do you operate?
  • How are service fees structured – percent based on total billed, or total collected? Any start-up or one time fees? Are terms month to month or longer term?
  • References – Can you share some references? May we contact the references? We will ask questions such as how long they have worked with the biller and their overall experience.