5 Tell-tale Signs You Need to Switch Your Billing Company

In healthcare, many people compare a practice’s relationship with their billing services provider to a marriage. True to this comparison, practices and billers can enjoy a prosperous relationship if it is built on trust and communication. Whether your urgent care does billing in house or with a third party, your billing provider is the key to your practice’s overall financial success.

If you are suspicious your biller relationship is turning south and you’re thinking about cutting the cord, it’s important to evaluate the facts. Knowing the warning signs ahead of time can give you an understanding of when it’s time to move on and find a new billing partner.

Sign #1: Lack of Efficiency

If you’re frequently double checking claims for your biller or fighting high amounts of claim rejections, there’s a problem. If your biller is double entering claims into software, you can avoid this by using an integrated EMR and PM, rather than having a stand-alone PM. High days to bill means your biller isn’t getting to claims fast enough—or your internal processes (like providers not locking charts) need to be improved. Either way, you need to look at why you’re not getting paid fast enough.

Sign #2: Lack of Communication

Lack of action is an action. If you can’t get a word in edgewise with suggestions or questions, you aren’t top of mind for your biller. A good biller replies, and even points out workflow suggestions to make your revenue cycle better. Waiting weeks for a response to an email is not normal. Measure the average response time (and helpfulness), and if poor, address this with your biller and set clear expectations.

Sign #3: Poor Transparency

If your practice isn’t getting the reports that you want, you should be nervous. Your billing company should be able to accommodate your data requests. At the end of the day, this is your money that we are talking about. Hiding information, or simply “forgetting” to share it, is a sign of mistrust. Key numbers that show your clinic’s true performance shouldn’t be difficult or time consuming to generate if your biller has good internal processes. Your practice depends on you knowing.

Sign #4: Not Meeting Benchmarks

Benchmarks always sound good. But make sure you compare your billing company’s standards with those in the industry. Are the numbers really as good as they sound? Look deeper at what true benchmark promises are, and if your biller is actually reaching them for you. Days in A/R*, reimbursement per visit*, percentage of rejected claims—these are the numbers that matter.

*See average days in A/R and reimbursement per visit for urgent care in the 2014 UCAOA Benchmark Survey Results.

Sign #5: Not Staying Relevant

In the coding world, staying current is everything. Staying relevant means correct claims and correct reimbursements. In 2015, ICD-10 will take effect, and you need billers who know their stuff and are re-certified to meet standards. Not only that, but having informed billers who stay up to date on laws and code changes is vital to compliance and consistent quality. Your billers are a reflection of your practice.

Conclusion

Many urgent care practices place a lot of time and faith into their billing company. Sometimes this is returned, and sometimes it’s not. Divorce doesn’t have to be inevitable though. A business relationship can be saved, and even made stronger, if both parties are vested in making it successful. But it takes both sides.

The question isn’t whether you should have in-house or third-party billing providers. There is no golden rule on the format of what works best; pros and cons exist for both options. Your question should be whether your billing provider is the best match for your practice. Can they grow with you? Are they reaching your goals? Are they a true teammate? Base your decision on the facts, and don’t ignore the warning signs.

What warning signs about your billing company do you think are important to watch for?