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Revenue cycle management

We all know the glitches with EMR and the time and dollar required to fix it. For past 5 years EMRs are not only providing clinical services but most of them have started their own revenue cycle management services. Yes, we all are a slave of technology because we have experienced the positive sides of productivity and cost control.  And we do like to automate tasks like posting payments, sending reminders to patients regarding their balance, generating reports etc to reduce cost and time spent.

Since RCM services provided by the EMR vendors promised to be the most cost effective in dealing with the business side of a practice, charging only 2.99% to 3.99%, medical practices mostly the independent practices chose to work with them.  Medical practices who had their billing in-house for almost 20 years, decided to outsource their billing to the EMR’s RCM service.

Some EMR billing services come with a contract of three years. The EMR billing services proved to be excellent during the first year. And then as the clients became older and seemed like never to go, started facing the dark side of what they never experienced. For others they had to see the worse at the beginning of the service.


                 What do billing managers complain about working with EMR’s RCM services?

As it is not programmed by a doctor OR the providers didn’t consult the doctors so how would they know to deal with the inadequacies of a system?

Collections plunged in a matter of months: Medical practices experienced a marginal drop in their revenue within months. The most common reasons for the cash drop, pointed by billing manager:

Payment posting is delayed, inaccurate or missed:  Billing managers say they have to babysit each EOB and batch to ensure that there zero errors in the patient’s accounts.

Contractual Obligation (CO) seems like just a paperwork:  It is frustrating when you log in to see no payments posted. You call your vendor only to be transferred to customer service. The customer service rep makes you hold for a long time only to get a ticket. And yes, the language barrier and lack of knowledge about the healthcare terminologies, the most commonly reported issues. So here’s the question, what about the contractual obligation?

Hidden costs are the most painful:  When it comes to choosing an EMR system, we all do a price-performance analysis. But multi-provider practices say, “Every time we approached the vendor, we were charged”.  A practice manager at a multi-provider practice based in Florida, which used the EMR’s RCM services for almost 3 years said, “We wanted to opt out of their EMR but they asked us $5000 per provider to move our data on a hard drive”

The outsourced billing team wears your hat: It was shocking for the doctors to know that billing company executives used their staff’s name to deal with the payer’s tricks. Medical practice’s staff got irritated when they were not able to login to the providers portal of the payer’s website.“They changed the username and password to the providers portal without notifying us”, said an office manager of an ENT office based in California.

When you are not allowed to come out free: There are thousands of independent practices struggling to get back their billing in-house. The only choice they are left with is to pay the balance their provider quotes them. This balance is not a matter of $500 or $1000 to which seems to be manageable. Almost 90% of the independent medical practices who complained about their provider say that they have been notified to pay up to $10000 in order to opt out of the current service.

Of these 70% of the respondents who asked their providers to stop the billing, were prevented from getting any upgrades and bug fixes to their EMR. Physicians complained that this impacted their ability to prescribe certain medications for their patients. They also complained that implementation of some features on the application requested by CMS, was withheld affecting the efficient patient care.

Is 2.99% only collected as promised? And what if it increases anytime? If you believe the advertisements you saw and signed the agreement, could get you into more serious problems than the ones I talked about. Physicians complained that they always got a bill more than what they believed to be. A doctor of a cardiology practice based in New Jersey says, “We called them to find out why we have to pay this bill. On what factors do we pay you? We have not received any reports till date”

When a ticket is closed without any resolution:  Any system may be capable of handling your billing needs but the support required to maintain it is pretty challenging. The IT staff at medical practices complains that the most challenging job was to get an accurate and timely resolution from their vendor.  It was frustrating to be put on hold and then transferred to a different department. At times the support representatives closed a ticket after replying to their email.  How can you close a ticket when it’s not resolved”, says an IT executive of a medical practice based in South Florida.  

So how do you make sure you don’t face the above inadequacies? Most of you would be looking to get back your billing in-house or switch your billing company

           18 Questions you must shoot before choosing a new medical billing service!


#1.What is the level of experience with the EMR (years of experience by the team assigned to our practice)?

The company should have been working with the EMR for at least 10 years. And the team assigned to your practice should have a minimum of 5 years of experience with the EMR

#2.For how many specialty (your specialty) medical practices does your company currently furnish claims submission and related billing services?

The company must have done end-to- end Billing & RCM service for any specialty office. How much experience the team has specifically in your specialty? How experienced are the Certified Coders and Project Managers in managing your specialty clients?

#3.For how many years has the billing company been in business?

Make sure that the company is not new to the industry. This would highlight their capability and most importantly their relationships with their clients.

#4.Has the company operated under another name(s) and, if so, then what name(s)?

Do verify the multiple names if any and what other services the company provides.

#5.What is the nature/scope of any internal compliance plan(s)?

Check the compliance document from your billing company if they mentioned about it and verify the same with your legal staff.

#6.Did you check their compliance document?

How the billing company complies with privacy and security standards promulgated under HIPAA and HITECH, including regularly upgraded and/or updated firewalls, antivirus software, encryption and restricted access protocols.

#7.Has the company been in any legal issues?

Has the company ever been the subject of a state or federal “fraud and abuse” investigation and, if so, then what was the outcome?

#8.Has any of their clients been in legal issues?

Has any client of the company ever been the subject of a state or federal “fraud and abuse” investigation and, if so, then what was the outcome?

#9.Did you check the nature/scope of any internal audit system?

We don’t find time or ignore to read the compliance document but please do take out some time from you crazy schedule to not only read it but get a better understanding. Ask your billing company when you don’t understand their terms.

#10.Do you run/provide an audit report?

Does the company undergo periodic audits by a qualified independent third party and, if so, ask for a current auditor’s report or summary?

#11.Do you have Certified Coders on board?

Does the company have certified coders on staff and, if so, then how many

#12.Is there any staff training?

What is the nature/frequency of staff training? What is the agenda for the training?

#13.What is the nature/scope of pre-hiring background checks for staff?

Does the company run a credit check, fraud & abuse check, criminal check and refers with the previous employer.

#14.What are the coverage limits of commercial insurance?

What are the types and coverage limits of commercial insurance (e .g. , errors and omissions and theft, dishonesty and defalcation)l

#15.Did you check the details of the dedicated staff to be assigned to your practice?

How many years of experience does the staff have, assigned to your practice? Request to share their resume sand certification.

#16.What is the process and timing of the startup phase, including the mechanics of establishing VPN connectivity to the EMR system and training your practice personnel?

How much time it takes to set up the EMR? How much time it would take to complete the enrollment paperwork and submit it to Clearing House? How much time the Clearing House takes to get your practice enrolled for EDI?

#17.Do you have name/telephone number of contact person for at least three references?

Speak to the other clients (same specialty, using same EMR) of your billing company to help you know how the company responds to a query.

#18.Do you have a copy of standard service contract?

Do ask your billing company to send you a standard billing contract standard HIPAA Business Associate Agreement?

If you are about to sign a contract-then the above questions may change your decision!

Don’t let any of these questions go unanswered. It’s always better to test the skills and experience of a service before you sign up with. It’s not a newsletter subscription where pushing button will set you free in seconds.

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