How to select a Practice Management and Revenue Cycle Management partner


How to select a Practice Management and Revenue Cycle Management partner

Choosing a medical billing service is a complex and time-consuming task. 

You need a reliable and efficient medical billing company that seamlessly handles your healthcare billing tasks and frees your team from the tedious and monotonous work of handling patient data. 

With a multitude of vendors offering medical billing services, it’s harder to choose the right company. 

But don’t fret! 

If you ask the right questions and take the right factors into consideration, you can confidently pick the right vendor for your Revenue Cycle Management (RCM) process. 

In this article, you will discover the questions you need to ask to choose the right Revenue Cycle Management partner for your healthcare practice. 

Types of Medical Billing Vendors

Most medical billing companies come under one of the three categories: 

boutique, full-service or light. Depending on the services you require, you can choose an RCM partner. 


Boutique Medical Billing Companies:

These are medical billing services offered by “mom and pop” billing vendors. They offer effective oversight and specialize in a limited number of services. 

By charging premium prices, the boutique level billing companies take care of all the business aspects of running a medical practice. That is, they go beyond submitting, following up, posting, and appealing claims.  

Full-service Medical Billing Companies:

These are medical billing services typically offered by software vendors and many traditional billing services. 

Full-service billing vendors work with practices right from the beginning stages of revenue cycle management. That is, they provide training and technology tools to check on patient eligibility and benefits, demographics, and pre-authorization of insurance companies during the check-in process. 

They also help manage claim denials and offer input on how to avoid claim denials. This eliminates the need for skilled billing staff in your practice to work on claim denials. 

Light Medical Billing Companies:

These are medical billing services typically offered by numerous billing software vendors.

Light billing companies don’t take the responsibility for coding validations and working denials due to demographics, authorization, and eligibility of the patients. The practice must employ dedicated staff for the front end billing process to get claims accepted by medical insurance companies.   

Selecting the right Revenue Cycle Management (RCM) partner

Before you choose to hire a medical billing company, you need to find answers to a few critical questions. 


#1. What services will be offered? 

You need to figure out the level of service offered by medical billing companies. 

Here’s a quick checklist:

  1. Does the vendor partner offer to file paper and electronic claims?
  2. Do they handle your kind of work, i.e., Major Medical, Workers’ Comp, and No Fault billing?
  3. Are there certified coders on staff?
  4. Do the team members have a sound knowledge of medical coding and billing? Do they have a complete understanding of CPT-1, ICD-10 coding level I, II, III and HCPCS?
  5. Are they familiar with coding for your specialities?
  6. Will the vendor pursue denied claims? 
  7. What procedures does the vendor have in place to pursue denied claims?
  8. Who follows up if the patient doesn’t pay his/her bills?
  9. Will they correspond with patients regarding billing issues?
  10. Does the vendor comply with regulations such as the Health Insurance Accountability and Portability Act (HIPAA) for safeguarding patient privacy? 
  11. Will the vendor offer insights and suggestions to improve your practice’s financial performance? Or, simply send a single-page financial statement every month?
  12. Will the billing system lead to improvements in collections?
  13. Will they adhere to Turn-Around Time, crucial aspect of RCM process?
  14. Do they monitor payor contracts for underpayments and assist with the appeals process?
  15. Will the vendor help to enhance cash flow to the practice?

#2. How are technology issues being addressed?

When it comes to technology, as a medical practitioner, you want to know about a company’s information sharing process, data security, and procedures of recovery and data backup. 

Here are a few potential technology issues that you need to look out for:

  1. Does the vendor partner offer a practice management software with Electronic Health Records(EHR) system?
  2. How does the vendor share superbills and claims?
  3. How does the vendor ensure data security?
  4. Are there effective disaster recovery procedures in place?
  5. How and where is the backup data stored?
  6. Does the service provider access the system online or need to install and maintain software? 
  7. Do the technology and process ensure a high ‘clean’ claims rate? 
  8. Do they have a secured platform to exchange data ?
  9. Are their third part tools HIPAA complaint (Faxing system, phone services?)

#3. What are the pricing options?

Most medical billing services, as a standard, offer three popular pricing models. This includes Percentage-based, Fee-based, and Hybrid models. 

  1. Percentage-based models, the most popular pricing structure in the market, charge a percentage of total collections or gross claims submitted.
  2. Fee-based models, a cost-effective option, charge a fixed dollar rate for every claim submitted. 
  3. Fee-based models, a cost-effective option, charge a fixed dollar rate for every claim submitted. 

You need to choose a vendor that offers the best pricing model for your practice. 

#4. What is the reputation of the vendor?

Lastly, what must be considered the vendor’s reputation – their years in business, clients served, certifications, testimonials from other physicians.

Now that you know what questions to ask and factors to consider, go ahead and select the right partner for your practice management and RCM process. If you need to improve your collections and streamline your practice administration process, this is the right way to go.


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