Of all the outsourcing decisions that radiology practices must make, none might take as long as deciding whether to outsource medical billing and coding. This is due, in part, to the fact that billing is the company’s cash register, so to speak, and is therefore more likely to be scrutinized —even agonized over—than are other services. As reimbursements decline and operating costs rise, outsourcing can be an attractive option for practices that want to reduce rent, hardware costs, and employee-related expenses, and some practices have elected to outsource such functions as transcription, electronic filing, IT, and technologist staffing. Nonetheless, the decision to outsource billing and coding is one of the most important that a medical-imaging enterprise can make. One medical-billing resource, for example, has estimated that approximately 25% of all medical-practice income is lost due to underpricing, undercoding, missed charges, and unreimbursed claims. With so much at stake, and with so many outsourcing options available for billing, it can be difficult to determine not only whether to outsource, but to which company. W. Scott Cubellis, president of Affiliated Professional Services (APS), a medical-billing service based in Wareham, Massachusetts, offers the following guide to navigating the crowded medical-billing waters. There are five key questions that a radiology practice or medical-imaging center should ask of a prospective medical-billing resource, he advises. Question 1: The first question applies to practices currently doing their billing in-house. “There are probably going to be some concerns about the future of the billing staff’s members, some of whom might have been with the business for many years,” Cubellis says. “In those cases, the question is, ‘How will you handle, or help us handle, the staff transition?’” Look for a billing company that is willing to work with someone assigned by the facility to help formulate a plan that is the least disruptive to both the organization and the individuals on the staff, Cubellis recommends. “The new billing company should not be in a hurry to cut them off in a day, close up the in-house billing department, and lock the door,” he adds. “Transition should be done in a professional, courteous manner. Look for a company that knows that it is coming in to replace the billing staff, but that also knows that these people have bills to pay and families to support.” Question 2: The next question addresses the concern that partners and senior management might have about assigning financial responsibility to a company that is off-site. “Many stakeholders believe that if they can’t see the process around them, they don’t have control over the billing,” Cubellis says. “It’s the loss of control over this that keeps them awake at night. The second question is, ‘What steps will you take to hold yourself accountable to us for your activities?’” Question 3: When billing is outsourced, a natural transition period ensues (just as it does with other services) as responsibility changes hands. If the transition is not performed according to an established plan, it could produce a disruption in cash flow. “Many decision makers have heard horror stories about how long it takes to get their receivables up to their current level,” Cubellis says, “but if it is properly executed, the transition is seamless and should be completed in about 90 days.” A competitive advantage of APS is its proprietary software (which is customized for each customer), effectively smoothing the transition. The next question is really two, Cubellis says: “How long will your transition take, and can I expect any drop in collections as a result?” Question 4: More businesses of all types are relocating some of their departments overseas, where cheaper labor helps them remain competitive and profitable—but Cubellis warns that offshore should be off limits. “What is happening in medical billing is a reflection of what has happened to radiology,” he explains. “Sometimes, images are being read, say, in India, when they should be read here. Some billing brokers get an account and pass it along to a clearinghouse—sometimes overseas—that does all of the processing. The fourth question is, ‘What is the location of the facility that (or people who) will be processing my claims?’” Question 5: Fifth, Cubellis recommends asking about follow-up and follow-through. “Medical billing is a service industry,” he says. “Credibility depends on keeping promises and producing results. It is important for customers to know who is in charge of their accounts and who will be responsible if there are any problems or questions. There should be complete ownership of responsibility somewhere in the billing company.” He continues, “For example, our New Client Implementation Team is composed of the highest-ranking employees in our company. On the day we start, we are submitting claims—so in the first month, there is typically little (if any) disruption in the client’s cash flow. The team is there for the life of the relationship. To ensure the best service, the last question also has two parts: ‘Who will be handling my account, and what is his or her experience in the medical-billing field?’” Medical imaging continues to receive broadsides from various private- and public-sector entities seeking reductions in reimbursements and increases in oversight. As these efforts continue, it has become more important than ever to reexamine the value of each department to determine whether—and how—efficiencies can be gained. “Everyone is facing declining volume and declining reimbursements, as well as increased denials,” Cubellis says. “Outsourcing medical billing is often the answer to one of the efficiency challenges, but the decision is important, and it requires research and education.” Steve Smith is a contributing writer for imagingBiz.
5 Key Questions to Ask a Prospective Billing Service