Revenue Cycle Management: Interview Pointers for Selecting an Outside Billing Company - Management Resource Group, LLC Revenue Cycle Management: Interview Pointers for Selecting an Outside Billing Company - Management Resource Group, LLC

Revenue Cycle Management: Interview Pointers for Selecting an Outside Billing Company

Practice Management

In your business, every CPT code, every patient encounter, and every dollar should matter. Mistakes in your revenue cycle process, including errors in coding and failing to collect delinquent balances will lead to lost revenue. You may find yourself considering the use of an outside billing company to manage your accounts receivables if you are facing challenges with this part of your practice.

Due diligence is an important step when searching for a medical billing company. For many providers this is a big leap into the unknown. Many RCM firms advertise that they are “Full-Service.” In reality, some of these companies may merely file claims and post payments. These companies may delegate denials, claim rejections, patient phone calls, and outstanding claims back to their client for review and correction. Those services sent back to the client take the most time and effort to manage. It is critical to review the responsibilities of the billing company and to be sure that your agreement clearly states what is included in the fee.

When considering a proposal, you should know who is responsible for these functions:

* Posting patient payments collected at time of service
* Coding (ICD-10, CPT, modifiers) for services provided in office, hospital, and other locations
* Charge entry and/or importing charges from your EHR
* Correcting front end edits in your billing software
* Filing electronic and paper claims
* Correcting electronic claim rejections and patient demographic information
* Refiling corrected claims, managing denials and submitting appeals
* Processing returned mail
* Posting ERAs, mail payments and processing credit card payments
* Processing patient statements and answering patient billing calls
* Following up on patient balances and subsequent collection activity
* Following up on delinquent insurance balances
* Provider credentialing with insurance carriers including electronic deposit enrollments

Our MRG professionals individually customize and design our engagements to specifically meet the needs of our clients with the job responsibilities and associated fees clearly stated. We do NOT require long term commitments, and in many cases, a change in billing software is not required. Our trained professionals have the skills to provide billing services on a number of different software platforms.

When reviewing proposals from different RCM companies, it is critical for you to compare the responsibilities and associated fees. A lower rate may sound appealing, but if you are unable to reduce practice expenses related to this process (like employee payroll costs), you may need to consider looking at other vendors. Ask the billing company important questions such as who will handle denials, rejections, A/R follow-up, patient statement inquiries, and electronic claim errors. Request a detailed listing of all services that are included in the fee. Check references! Be sure the references are similar to your practice in specialty and size. It is also important you have an account manager assigned to your business with email and telephone access. Communication is always key when working with any outside vendor.

If you would like MRG to review your current billing practices or would like to complete a needs assessment to obtain a billing proposal, please contact Karrie Plaskett at or via phone at 1-888-818-0563 EXT 317. 

Our Partners

Aligning ourselves with business partners that offer the same high level of service, integrity and comprehensive healthcare solutions is the cornerstone of our business model and complements our mission to serve our clients.

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