In determining the qualifications of a billing service, or in setting criteria for how your own patient accounts will be handled, the answers to the following questions may be of help.

  1. How many full-time equivalent staff members does the service employ relative to the full-time equivalent physicians/providers for whom they bill?  (Something close to .5 full-time equivalent staff for every full-time equivalent provider is good.)
  2. How are collection staff organized – by payer type, by practice, by physician, or in some other way?  (Organization by payer type is preferred since the rules of every payer are quite unique and staff can be more efficient and effective when they specialize in a particular payer category such as Medicare.)
  3. Please provide a sample of the standard month end reports which will be provided to the practice.  How many of these can we choose to have supplied each month at no additional expense?
  4. What manually prepared reports will be supplied by the billing service each month?  (Someone should take responsibility for developing a summary, standardized report by physician and by site, which includes reporting on total charges, total adjustments, total cash receipts, total refunds, gross collection ratio (by payer class) and months in accounts receivable.  Monthly and year-to-date numbers should be provided.  Gross collection ratio and months in accounts receivable should be reported on a twelve-month rolling average basis.  Commentary should be included.  Aged accounts receivable, by major payer class and in total, should be provided.  (If the billing service doesn’t do this, who will?)
  5. How will the deposits be made?  (Directly to a bank account in the practice name?)
    1. Who will write the cash control policies for the group and for the billing service?
    2. Who will write the policies regarding accounting for all patient services provided (both in the office and off-site, i.e., at the hospital, a nursing home, etc.)?
  6. Provide a “chart of accounts” with definitions showing the charge, payment and adjustment codes which will be used by the billing service to post activity/transactions to your patients’ accounts.  Indicate specifically which staff have the authority to use each of these transaction codes.
  7. Provide a written policy on day-end and month-end closing.
  8. Provide a written policy regarding collection agency use, how those accounts are posted, whether they remain in the active accounts receivable, whether they are written off completely when transferred to the collection agency, or whether they remain in a “separate” accounts receivable total (financial class).  What collection agency do they use/recommend? What is that agency’s collection rate?  Does the agency send payments gross, or net, of their fees?   Provide detailed written procedure for how these are posted to patient accounts with example.  What procedure is followed before an account is sent to collection (i.e., what follow-up is provided for an account monthly, who authorizes the account to go to collection, etc.)?
  9. Provide a written procedure for the posting of capitation charges, payments, withholds and risk pool monies.
  10. How are insurance claims filed (Electronically?  On paper?  How often?)?
  11. Do they use a clearinghouse?  If so, how are the fees for the clearinghouse billed to the physician group?  (Included in the billing service bill?   If not included, how much are they?)
  12. Do they use electronic payment posting?  If so, for how long and how successfully, and for what payers?
  13. How do they propose to communicate with staff about billing errors and problems?
  14. What is the process for making certain that superbill and diagnosis coding are current and appropriate?
  15. Do they provide coding reviews and educational services for physicians and their staff members?
  16. Can you provide a compliance policy?  Do you offer complete compliance packages?
  17. What adjustments must be approved by someone outside the billing service?  What adjustments do billing agency staff members and supervisors/managers make independently?
  18. Define and delineate examples of the impact on billing of the following terms:
    1. Participate
    2. Accept Assignment
    3. Insurance Only
    4. Courtesy
  19. How are monthly statements prepared?  When are they mailed?  What is the cost?
  20. Is their fee based on net cash receipts (cash receipts less refunds)?  Does that include all capitation payments (risk pool returns, withholds returned?) or gross charges?
  21. What decisions must we make before you can start billing for us?  Please provide detailed list of all options.
  22. Do you employ certified professional coders?  If so, how many?  How are they involved in the billing service?
  23. Will your software system create our superbill/routing slip for us automatically each day based on the day’s appointment schedule and track those patients automatically for whom we have not posted a charge but who were on the schedule?
  24. Does the software allow for physician scheduling?  Room scheduling?  Resource scheduling?
  25. Can we do patient recalls with the system?  Provide example report.
  26. Can we track referral sources with your software?  Provide example report.
  27. Will we have an account representative?  If so, who will that be?
  28. What is the average number of years of physician billing experience of your line staff?
  29. What is the process by which your staff follow-up on insurance claims which have not been paid? Provide written procedure.
  30. Where can we visit an operation which is doing business in the same discipline as our practice and under the same payer mix?
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