Practice Management

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  • 1.  outsourced billing

    Posted 04-07-2022 12:34
    Our group is considering options for outsourcing of billing.  Curious if anyone has been through the process lately? What sorts of vetting did you do? What metrics did you focus on when evaluating a group?

    Thanks for any insights!!

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    Carrie Moore
    Director Reimbursement Operations
    Wichita Radiological Group, PA
    Wichita
    (316) 683-1367
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  • 2.  RE: outsourced billing

    Posted 04-07-2022 14:43
    As someone who recently came from the outsourced billing/vendor side, I have many thoughts. This is just what I could come up with off the top of my head. Feel free to private message me if you want to chat. For me, being a math nerd who likes to look at reports and manipulate data, the reporting capabilities are the most important to you. Each person will have different priorities though. 

    I would ask about these tasks/programs/employees:
    1. Reporting/software - what type of reporting programs will I (as the client) have access to? paid or free? such as Power BI products
    2. Reporting - Provide copies of existing reports that you frequently use and ask the RCM if they can reproduce those reports? could they be produced on an ad-hoc basis or could they only be produced monthly? What's the typical turn-around time for those reports? Who actually produces them (the client manager, a specific data analyst, the billing vendor's software company, etc)? 
    3. Reporting - Key performance metrics (KPM's) - i would like to see a report with KPM's that I could receive every month from that RCM
    4. Software - I would like a demo of the client's access to the billing system to see how user-friendly it is
    5. Coding - Insufficient documentation on rad reports--how does the RCM handle those reports? 
    6. Coding - MIPS program- what is the RCM's current or preferred registry vendor and what does the client interface/report look like? 
    7. Coding - If you perform E&M's, does the RCM have a certified coder to answer your E&M questions and provide education about reporting requirements? 
    8. Coding - Does your RCM have an education team that can educate you and your clinicians about coding changes?
    9. Employees - Where are the customer service agents located? That could have an impact on your patients/callers if there is a language barrier. 
    10. Employees - Where are the A/R, data entry, coders, etc, located? If any are offshore, this could pose as an issue if your hospital system prohibits non-US based contractors from accessing EHR systems. (i.e. EPIC specifically forbids foreign access)
    11. Coding - Does the RCM use an autocoder and to what extent? What's the QA process? 
    12. Interface/programming team - what is the typical turn-around time for setting up a new interface? What products/programs does the RCM have if the interface is not in HL7 or text? (i.e. some smaller facilities still use PDF). 
    13. Denial management - what tools/processes does the A/R team use for denial management? First in, first out? Is there an AI program that escalates higher dollar claims? I would actually like to see a workflow of each denial code. 
    14. Enrollments - who handles the insurance enrollments and who monitors the existing enrollments?
    15. Insurance eligibility - does the RCM have any software or capability to scrub claims against an eligibility database to see if the insurance on file is valid or find new insurance if none was provided? 
    16. Client manager - who will be the assigned client manager? will all communicate funnel through that single person?
    17. Billing office - where will my claims be billed out of?
    Each RCM will have their proprietary or unique offerings like software, reports, etc. I would ask how many rad clients from that billing office are actively using each product or feature. The sales teams for RCM's often advertise features that haven't been rolled out to the general client base yet. 

    I would also keep in mind that reports can very easily be manipulated based on definitions. For example, Net Collection Rate is fairly notorious for being defined differently by different RCM's in terms of which denial codes count as contractuals and which could as write-offs. 

    Good luck!

    Janene W. Markuske
    Executive Director

    IntelliRad Imaging, LLC

    Miami, Florida



    Cell: 727-244-7542

    Fax: 305-397-1139


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