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written by: medvertex | October 17, 2017 | 0 Comments

5 Steps To Switching Into a ‘Healthier’ Practice


Are you committing doublethink?

How is your cash flow really doing? If you have tothink twice about it, chances are you might not be in a great situation. Perhaps it’s time to give your RCM vendor an internal audit.
It’s obvious that every service-oriented medical practitioner wishes to increase the flow of revenue while receiving outstanding service. This is where your medical billing company comes in handy, they should go to bat for you so you can put your mind at ease.


Below are considerations when making the choice to switch.

1.Level of service

As a medical practitioner on the lookout for a new billing company, you need to look analytically at the level of service. Your business is paramount and should not be compromised at any stage.

How the firm pursues denied claims – Are you the one to go after denied claim or is your RCM vendor taking up the pursuit.

  • What are the industry averages and is your vendor performing above these?
  • Speed to correct the denial. How fast is your vendor actually pouncing on these denied claims? Are they accountable?Remember, this is a team Your company is only as strong as the weakest link. Why let your vendor be that link?
  • Don’t be left in the dark and taken advantage of.Denied claims take a lot of time and resources. Your system should be “automated” (behind the scenes) does it appear to flow effortlessly?

Analysis and making reports– Since the medical billing company are believed to be experts, they should be able to draw analysis and come up with possible strategies and suggestions on how to enhance your practice

  • Are they going that extra mile?
  • Denied claims – What were the reasons behind these denials? Numbers are great, but they don’t take action. Your RCM vendor should be offering practical, and actionable, advice for continuous improvement. Why throw your cash blindly into the abyss? Knowledge is power, keep your company strong.
  • Anyone can simply oversee, true improvement takes experience.

Compliance with regulations– A good billing company, must be able to adhere to norms and rules. When a provider issues out a patient’s medical information to a third party, such provider becomes responsible for the third party’s action with such. Therefore, you need to know the level of compliance of your potential billing company with regulations.

Follow up of bill– A scenario where your patient fails to pay up bills, who does the follow up?

  • If you find yourself doing all the heavy lifting, how can you justify shelling out a growing overhead in order to do the work yourself. You shouldn’t.
  • Remember, your RCM vendor is on your team. It’s important to work as a unit in order to both grow.
  • Keep your focus on your patients, their life’s quality is paramount to you. Let your vendor take care of the numbers.

2.In depth knowledge of coding and billing process

Different payers have various means of payments and coding requirements. Your RCM vendor should know how to navigate all types of scenarios.

Staying up to date – An in depth in-depth knowledge of how to use HCPPCS Level II codes, CPT codes and ICD-10 codes to analyze and report services is essential, especially if you are writing checks every month to streamline your process.

How do they learn – An RCM vendor should be staying up to date in the latest industry trends and have a passion for improvement.

  • Are they attending seminars, conferences? The world of healthcare is constantlychanging. For you it could be a full-time job simply staying up to date with the latest regulations. Do you work with Medicare? As you know, this can be a complex time-consuming entity all by itself.
  • Spend your time where it’s needed the most and do what you do best.

3.Access to efficient and latest Revenue Cycle Management software

As a physician or a project manager on the lookout for a new billing company, you should consider a firm that can provide top notch software developed to generate revenue at the best level.

Meshing technologies with existing systems – You wouldn’t let a dinosaur manage your growing revenue flow, would you? Then make sure your RCM vendor is using the latest and greatest technologies.

  • The software should sync with your existing systems. Let’s face it, in the 21st century computer viruses, bugs, and malware run rampant. Your information, patient data, and processes, are critical to moving your business forward.
  • Your qualifications and their compliancy, are only as good as your internal vendor’s processes and software.
  • Are they suggesting KPIs for your practice? HINT: They should be.Are these indicators being presented to you?
  • Collection rates
  • Denial rates
  • First-time claim acceptance rates
  • Days In Account Receivable
  • Percentage of Accounts Receivable Over 90 Days
  • Average Payment Per Encounter


Managing your revenue cycle should not be given to just anyone- In addition to knowing latest codes and how to identify claim discrepancies, any medical billing company you need to hire must have certification from at least one of the two principal bodies

  • AAPC: American Academy of Professional Coders
  • AHIMA: American Health Information Management Association

5. Experience and specialty in your area

Your preferred choice of billing form must have an extensive list of satisfied clients and proven track records. While some good companies may be good at what they do, medical billing company with several years of experience in the healthcare industry is a plus.

Talk to their clientsWhat are their current and past clients saying?

  • Do their clients sing their praises or are they merely a bystander.
  • Does your RCM vendor have a performance guarantee?
  • A good RCM vendor will be engaged from the day they start to day 1000, there is no backtracking.
  • Remember, you are choosing a strategic business Why settle with the traditional vendor? You and your business are unique, it’s time to act accordingly.
  • Are you saying, “I didn’t know that existed?” Your vendor, should be analyzing trends (both internal and external) for your practice.

Birds of a feather…flock together – Your practice is unique. If your specialty is a physical therapy, family, or other specialties, ask your vendor if they specifically have your specialty RCM experience. Choosing a billing company that has vast experience in your niche will save everyone involved valuable time.

  • Case studies speak volumes.
  • Personality first. Your vendor should be easy to communicate with and more than just numbers and have a knowledgeable approach to not only medical financial cash flow, but they should be human. Just because you might not interact with your RCM vendor on a daily basis, this doesn’t mean that they shouldn’t be personable when you do.
  • This not only streamlines the operations but also improves overall experience.

Bottom line

Trust your gut, you know your practice best. If you have to doublethink your decision and something just doesn’t sit right, chances are you may be in need of a company checkup.

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Over To You……

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