Tips for Selecting a Claims Management Partner

Thinking about hiring a claims management partner at your organization?

Outsourcing aspects of your billing often comes with benefits as well as challenges that can affect your software, revenue, employees, and workflow. It is important that you take time to evaluate your needs and consider some of the following strategies to ensure your outsourcing initiatives succeed.

One Size Fits All? 

Keep in mind that medical billing services typically are not a “one size fits all” solution, so it makes sense to do a thorough evaluation. Billing companies often differ in fee structure, services offered, systems used, communication style, results, and many other characteristics.

For example, you know the owner of Company A from a local organization, but they don’t provide some of the services you are considering. At the same time, Company Z offers some of those services, but they are based outside of your state, have some negative reviews, and the cost is extremely high.

The choice you make in selecting who to partner with can have a lasting impact on your organization, so weigh all the pros and cons when identifying which services are the best fit. 

Do your due diligence, get feedback from others who are currently working with the vendor. It’s expected that you ask for references. It may seem obvious but ask for references that are similar to your organization in size and in the systems they use. You will benefit most from a partner that has worked with organizations or practices like yours and has experience adapting to industry changes.

Cost as a Key Factor

There is a reason why the saying "Too good to be true" has staying power. Cost is an important factor, but it should not be the determinative one. 

Costs will include start-up fees, termination fees, data conversion fees and any other additional costs. Be sure to discuss all these costs with the potential business partners. Try to understand possible hidden fees and ask about them, but most importantly, be sure you have discussed in detail anything that your office specifically needs.

Some vendors strategically bid low prices because they know how much cost factors into the decision making process. Then once they have the contract signed they underperform or shift costs to the provider.

When evaluating cost, make sure you consider duration as well. Do you want an annual contract or do you want the project based on achieving certain initiatives. Sometimes the best partnerships are when a vendor is selected to assist a provider in building an internal resource or a short-term A/R cleanup project, then hand the keys back over to the provider at the first project milestone.

Revenue Cycle Matters Tip: Ask how prices are compiled and read the fine print in contracts. Better yet, have your account or attorney review the contract to be certain you did not miss anything. For example, if you're not happy with the service, what does the termination clause require? Note any key dates for giving notice so that you do not get caught in an auto-renewal situation with a company that is not working out. 

Implementation and Training

For some revenue cycle managers, the risks of getting into a bad partnership outweigh the benefits of outsourcing, which can threaten the job security of staff. Despite this, responsible revenue cycle managers must learn to discern the opportunities for revenue cycle improvement by exploring the pros and cons of launching a new project with an outside vendor.

Think about every department that the outsource vendor will encounter. Get people from each of those areas involved in the selection process.

How does the vendor train their staff? Make sure all staff is certified and ensure they receive ongoing training. How easy is it to make the changeover? How is the work being divided between the vendor and your team?

An issue we hear about often, is when vendors paid on contingency cherry-pick easy high-dollar accounts and ignore the challenging ones until you are forced to write them off. Make sure you communicate your expectations before signing any contract to ensure you avoid a similar scenario when the project kicks off.

OS inc. subject matter experts have worked diligently to create a training curriculum that supports the development of healthcare organizations' business offices. We use the same curriculum for training our internal teams and onboarding new A/R billing and coding professionals. It's a proven part of why our business office solutions deliver great results to our clients. 

Don’t assume that any vendor can offer every service you need. Ask upfront and be sure to know if there are services that they do not offer and what else they can offer for future opportunities.

Sharing Results and Updates

Will you get the status and performance reports that you want from the vendor? How often will you receive those reports? Will you hold weekly calls to discuss progress, updates, and strategy for more challenging or new work?

Remember, when you decide to go ahead and outsource revenue cycle responsibilities to a third party you might not know who is working on your claims; that job is delegated to one of the employees of the vendor. It is a good idea to ask for weekly reports that will allow you to monitor the value the vendor is adding to your revenue cycle. It’s your responsibility to make certain that you’re getting the level of service that you’re paying for.

The more transparency you have, the more effective the relationship will be. 

Additionally, after sharing organizational goals with team members, empower them to set their own specific goals and success criteria. They can ask for guidance but allow them to develop their own plan to achieve “success.” This gives them ownership over their tactics for “getting to green” and makes them more likely to achieve their goals.

There’s no silver bullet when hiring a vendor to outsource hospital billing offices tasks. Take the time to do your due diligence upfront. The more you do in advance, the better your chances for success will be and a productive, long-lasting partnership could develop.

Our Promise

At efficientC & OS inc., we promise to help our customers get 95% of their claims paid in twenty days or less. For us to achieve our promise, we must take an active approach to denial prevention. We know that if a claim gets denied, there is a 60% chance that claim will get denied again. Why take that risk? When implemented correctly, our customers have seen on average a 15% cash flow improvement and a 40% reduction of denials in sixty days.

Most claim scrubbers have the data you need to be successful. If you are struggling to find the data, reach out to your current vendor/partner and ask for assistance. Chances are, other customers have asked the same question and they can point you in the right direction.

We hope that the information that we have provided today can help you and your organization take steps to implement a denial prevention strategy. It might take some effort to get started but in the long run, it will increase collections and speed up your A/R turnaround. If you need some help getting started, reach out to us at efficientC. We would be happy to provide a free denial analysis. It’s time to make your denials work for you. We are here to help.

Do not forget to subscribe to Revenue Cycle Matters for healthcare billing best practices and industry tips!