Working with an outsourced medical billing company can improve the workflow in your practice, allow you to take some of the work off of your team members and help bring in reimbursement faster. And according to one Medicare Administrative Contractor (MAC), it can also put you at risk of reputational harm and HIPAA violations.
Background: On January 11, Part B MAC Palmetto GBA shared a provider alert cautioning practices about working with outsourced medical billing company employees. Find out what their concerns are and get tips on how to avoid similar issues.
Excessive Outsourced Medical Billing Company Calls
Palmetto’s latest alert warns providers to consult with their medical billing company reps about unnecessary calls to the MAC’s phone line. CMS requires providers and their billing companies to use the interactive voice response (IVR) system to verify eligibility and claims status, but some billing firms are bypassing that system and calling to get general Medicare coverage and billing information that they could find using the internet or by consulting local coverage determinations.
Palmetto notes that it will be calling practices “to discuss their vendor’s activities that are unnecessarily and incorrectly tying up the phone lines.” If you want to get ahead of this type of warning from your MAC, reach out to your billing firm now to ensure they are using the MAC IVR and that they don’t contact your contractors with general questions. Remind them that you are able to field such questions in the future. This not only saves you from issues with the MAC, but can also show you if your billing organization is unskilled. If they begin calling you with general questions about coding and billing, you may start to get the feel that they aren’t as professional as you were led to believe.
Palmetto also warns practices that it is the provider’s responsibility to guard PHI and not the outsourced medical billing organization. “So, if a PHI disclosure were to occur, the provider would be held liable for any financial penalties related to that disclosure,” the MAC notes.
How to Protect Your Practice
The best way to ensure that you’re working with skilled, competent outsourced medical billing firms that don’t risk harming your reimbursements or reputation is to perform your due diligence up front and only hire an organization with experience in your specialty field that comes recommended by other practices.
Then, stay on top of the relationship by always monitoring their collection rates, their timeliness, their communication skills and their expertise. Evaluate whether they have a lot of turnover and if so, find out why. Perform risk analyses at the organization to determine whether any HIPAA vulnerabilities exist and ask for proof of correction if you find them.
It’s within your rights as the customer to ask questions and demand answers. If anything seems out of place at your medical billing company, always reevaluate the relationship to protect your practice.
Working with an outsourced billing company presents dozens of pitfalls, unless you know exactly how to manage them. Find out more during the one-hour online training event, Proven Tactics to Boost Your Outsourced Billing Reimbursement. Expert Owen Dahl, LFACHE, CHBC, LSSMBB, will share every strategy you must know to stay on the right side of the law, bring in maximum reimbursement and create a strong relationship. Register today!
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