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Evaluate Your Medical Billing Firm by Tracking These KPIs

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Evaluate Your Medical Billing Firm by Tracking These KPIs

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outsourced medical billing

Many practices find that outsourcing the billing function can help improve workflow at the medical practice, reduce errors, process claims faster and boost profitability. But if your billing partner isn’t providing you with reports, you may not be able to measure the most important key performance indicators (KPIs) that help you evaluate whether the relationship is actually cost-effective on your end.

Check out the following ways you can confirm that your outsourced medical billing partner is bringing in maximum reimbursement for your practice.

Request Monthly Reports When Forging the Initial Contract

The best way to set yourself up for success is to ask the outsourced medical billing organization to make reporting part of your initial contract. If you meet with a potential billing vendor that doesn’t want to provide you with regular reports showing their progress, then it may be a good idea to walk away.

In fact, the billing organization is likely to show you their reporting processes during their initial pitch. But you can ask them which reports they offer, and if you don’t see everything that your practice already has in place, then request those additional reports in your contract.

If you don’t request reports up front, you could find yourself being nickel-and-dimed later. That’s because some billing firms charge extra for generating reports that aren’t promised in the initial contract.

Nail Down How You’ll Receive These Reports

Your outsourced medical billing service should tell you how they’ll be providing you with the reports so you can ensure that their method will be easy for your team to access. Will they be submitting an Excel file with multiple tabs once a month? Will the reports come in separately? Or will you have access to a dashboard that shows the information in real time? This is usually the preferred method, but whatever you choose, make sure you have your request in writing when you create the contract.

Know Which Report to Request

To most effectively request the right reports, it’s important to evaluate what your practice currently creates and what would help you gauge the billing service’s success. Consider requesting the following among the reports you’d like to see from them.

  • Charges broken down by provider, payer, code: A very helpful report that every practice should have on-hand is a breakdown of charges by provider, insurer, procedure code, office location (for practices with multiple locations), and any other important factors.
  • Payments by provider, payer, code: Once you know what you’re charging based on the criteria outlined above, you’ll want to be able to review the payments coming in for each of those categories. Without comparing your charges to your payments, you’ll never know your success rate.
  • Payment adjustments: Your billing service should share information about any adjustments that the payer makes and why. That way, if there’s a big discrepancy between what you charged and what you collected, you can check the adjustment reason to find out the logic behind the difference.
  • Denial reasons: The outsourced medical billing firm should also track your denial reasons so you can evaluate whether anything on your end can be done to halt such denials in the future. For instance, if denials are happening due to missing demographic details, you can work with your front desk to get that information up front in the future.
  • Days in AR: It’s important for every practice to know how many days it takes to collect your outstanding bills from insurers, so the biller should be sharing your average days in accounts receivable (AR). This report should also tell you how many accounts are outstanding at 30, 60, 90 and 120 days. This can be helpful because if you see, for instance, that 90 percent of your accounts are still outstanding at 120 days, then you may need to have a harsh conversation with your billing firm, since they shouldn’t be taking that long to collect. Ideally, your days in AR should be around 30-40 on average.

Discuss Problematic Reports Immediately

When you review your billing service’s reports, it’s a good idea to call out any issues right away. For instance, if the billing firm’s collections rate is only 50 percent on average, that may be a reason to contact them right away to ask why half of your reimbursements aren’t being collected. Perhaps it’s a simple reason, like the insurer had a glitch in the system. But it could be a sign of a systemic problem (for instance, the biller failed to collect any patient balances that month), in which case you want to be able to address it immediately.

For more tips on how to boost your reimbursement by working with an outsourced medical billing firm, check out the one-hour online training, Proven Tactics to Increase Your Outsourced Billing Reimbursement. Billing expert Owen Dahl, LFACHE, CHBC, LSSMBB will walk you through every part of the billing firm relationship so you work with the right organization and maximize your reimbursement from day one.


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