Revenue Cycle Management Blog | GroupOne Health Source

6 Red Flags That You Chose the Wrong Billing Company

Written by Adrienne Schrimpf | February 16, 2016

Choosing a billing company is a big step. The quality of your billing services can make a big difference in your practice revenues, for good or bad. Choosing a billing company that turns out to be wrong for your needs can be an expensive mistake that isn't just hard to recover from but also hard to recognize until it's too late.

Yet many practices are guilty of subscribing to the sunk cost fallacy and have a hard time cutting losses when it's time to part ways with a billing company. If you're not sure whether your billing company is enough of an asset to your practice, here are 6 ways you can tell if it's time to try a different provider when your contract is up.

1. Their Coders Aren't Experienced in Your Specialty

If you run a cardiology clinic or a surgery center, you expect the coders handling your billing services to have experience with coding in your specialty. While an accomplished general medical coder is a valuable part of the team, there are some practices where you need a specialist coder in order to reduce rejected and denied claims and ensure you're being reimbursed optimally.

2. You're Locked into a Long-Term Contract

Be wary of long-term contracts with billing services, especially if terminating that contract early is expensive or difficult. Sticking with a contract until the bitter end may or may not be better than paying to get out early, depending on how much revenue you stand to lose compared to the cost of terminating the contract.

If you feel their contract term is too long, ask if a shorter one is possible. If the company isn't willing to work with you on the contract, it is probably best that you just keep looking.

3. You Can't Run Your Own Reports

Insist on being able to measure your billing company's performance yourself. If you rely on them to run all reports, you have to take their word that they're giving you a complete picture.

A good billing service will have no trouble with you running performance reports, and may even encourage it because they're proud of their track record. If you aren't able to run your own reports, your billing service could be hiding their performance from you.

4. Billing Is Exclusively Done on Their Software

In general, the more proprietary and less interoperable a billing company's software is, the more you should beware. Ideally, billing services should be able to do billing on your software if you want them to. If they insist on using their software, and you're perfectly satisfied with the software you have been using, it may be a good idea to explore alternatives.

5. They Do Not Provide a Service Level Agreement (SLA)

Service level agreements, or SLAs, spell out things like turnaround time for claim submission, clean claim rates, and what you're entitled to in compensation if the billing company fails to live up to the terms of the SLA. Without an SLA, you could be locked into a long-term contract regardless of how well the company performs.

6. Training for Your Team Is Minimal to Nonexistent

Part of choosing a billing company rests on how well it meshes with your practice staff and workflows. The company you consider should offer onboarding training and consulting, complete with information about how you can improve your practice's revenue cycle management and what you can do to avoid problems. If you don't have this, it's hard to be sure you made the right decision.

The billing company you choose to work with can make or break your practice. I've talked to plenty of clinics that have been on the verge of closing their doors before coming to us because of a bad experience with another company. Read your contract and understand what it should contain to ensure that the services you're signing up for will help your practice succeed.