Five reasons to change your medical billing

Five reasons to change your medical billing

The following is a column from Vachette CEO Mick Raich

“It seems during the time of stress, the weakness shows.” I heard this once and it stuck in my head. It’s readily apparent that we are in a time of stress in the revenue cycle world. Many national billers are struggling to meet their metrics and are failing due to the changes brought on by COVID-19 and the government response to this pandemic. 

As providers see their revenue dropping and watching their practices fail, many are looking at their revenue cycle and wondering what to do. As the revenue drops from poor service and business choices by medical billers, we at Stark are often asked, “At what point do I change my billing company?” 

Here are the top five reasons to consider when looking to change your medical billing service:

  • Are they being honest?

Remember, you are trusting your practice’s income and livelihood to this company. If you cannot trust them, then it is time to move on.

In my earlier life I worked with a large ER billing firm and my job as a client representative was to go to the groups and chat with them each month about their end-of-month billing reports. My manager at this firm was rather unscrupulous, and often would tell me what not to tell the client while also coaching me on lying to them about our services. I found this very disturbing and I left the company as soon as possible. So, trust me on this; there are billers you know who do the very same thing. If they lie to you and are not 100% transparent, then leave them.

In my current role as CEO of a medical billing auditing firm, we sometimes interact with practices where the biller will not allow us to audit their work. This is red flag and you should run kicking and screaming away from this situation since you won’t know what is being hidden from you. Most providers who hear this from their billers call me back and ask me to help them find a new billing service.

  • The numbers don’t match up

Reviewing the medical billing financials can be a daunting task, however, there are numerous ways the numbers can be presented and reviewed. The key factor is that the numbers should correlate to the work performed and the other reports presented. An example of this failing is when you see the accounts receivable numbers suddenly change, something I have seen several times in my career. Billers can change reports to show only the positive numbers and not the old accounts, or they remove certain financial classes to make the reports look better. If this is happening there are likely many more red flags waiting to be uncovered.

  • They want to perform a “revenue cleanup”

No, simply no. If your medical billing firm dumps a pile of claims off to collections that are 389 days old, then they are doing it wrong. You should never have a situation where a bunch of old accounts are suddenly sent to collections. These accounts should go to collection every month and they shouldn’t be 389 days old! But again, this is unfortunately common.

For example, many RCM firms laid off staff during COVID and now they are seeing these accounts from May and April aging out and going to collections. This is a sign of a biller who isn’t performing correctly. If you see an account cleanup and a large amount of accounts sent to collections, then someone is failing at their job.

  • They’ve lost revenue they can’t replace

Tracking incoming charges is important and there are usually numerous files to accumulate and correlate to properly build a claim. Again, due to COVID, many billers laid off IT staff, meaning no one was around to build these files and write these interfaces. This creates lost revenue. A good biller will spend money to rebuild the files and rebill the claims to fruition. A bad one has a bucket of excuses why your charge volume is lower than your actual work volume.

  • The service fails

It is sad to see, but many strong national billing companies are struggling with customer service.  After they condensed due to COVID they never rehired the key personnel to keep the clients happy. The loss of these key employees cannot be made up with new hires. Their longstanding knowledge of the client and their issues are imperative to ensuring the billing runs smoothly.  When they leave, they take all their knowledge with them.

You can often judge a billing firm by the tenure of their client managers. I have been lucky enough to be a client manager and also worked with some great client managers over the years.  We also see an issue with call centers as many billers are struggling to hire people to work at call centers, which forces them to go overseas with these services. This obviously creates its own host of problems. 

In summary, COVID is causing all of us a headache and the revenue cycle world is not immune to these changes. When you see the above issues affecting your practice, it is time to consider making a change and getting a new medical biller. Do not wait until your money tanks and you cannot pay your bills. 

Changing medical billers is painful, but if you manage the process and do your due diligence, then it can be done without loss. Not changing your biller when you need to can even be more painful. I have seen numerous groups lose hundreds of thousands of dollars because they simply did not want to change billers. 

Mick Raich has 40 years of healthcare experience and has spent the last 18 years as the CEO of Stark Medical Auditing and Vachette Pathology. These firms provide billing transition services, medical cycle auditing and financial practice management to a variety of medical practices, laboratories and health systems nationwide.