All right, and without further to do, I would like to introduce you to today's speaker, Dave Gickelo, President of Seminars and Consulting. So Dave, I'll turn it over to you. Okay. So hi, I'm Dave Gickelo. And just before we get started, let you know, I don't own a billing company. I'm not affiliated with a billing company. So I'm just sharing with you. I did work for in the billing industry with a billing company for over 30 years. So that but since then, I've started my own seminar consulting company. So what I still work with a lot of medical billing companies across the country. But I just wanted to make sure that everybody knows I'm not affiliated with anyone. So I'm not here promoting anybody whatsoever. So two things we want to do today talk about some of the things that you need to keep in mind when we're talking about medical billing company. And then we're going to go through a little checklist of what to do as you're assessing or thinking or choosing a company. So one of the things is, is what is your real reason for outsourcing? A lot of times people, you know, really don't aren't really clear of what to why, why do I want to outsource? Why do I need to outsource? So you and your team should have a discussion about what are your goals. And then the entire team has to agree with the decision. You know, let's say, for example, you do already have an RCM function in your office. Are you going to redeploy those people? What are you going to do with those folks? But you need to have them on board because I have seen it. If they don't agree with the outsourcing option, sometimes they can sabotage the success of working with an outside vendor. Other things you need to keep in mind is do you want to be able to access their system to see what they're doing for your practice or how you're accessing? But we'll talk about this again in the checklist. So again, why are you outsourcing? What are your pain points? Are you having challenges with denials right now? Who isn't, right? Is it coding errors? Do you need a company that specializes in coding? Is it trouble with collections trying to keep up with getting your patients to pay their portion of your particular bills? So these are some of the things you need to really discuss and inquire about with your team because when you're looking for a vendor, you're going to want to make sure that they can address these for you. So make a list of what services you're looking for. Do you need somebody to do coding? Do you need denial management? Do you want them to interact with your patients, meaning are patients going to call them with their questions about billing or do you want them to continue to call you? It could be set up either way based upon what your preferences are. Do you want them to prepare the refunds for you? Do you need bookkeeping requirements, payroll, accounting? Again, you want to have like an a la carte list of here's all the things that we'd like to have happen. That's a nice thing about dealing with medical billing companies. They usually will allow you to select and choose what portions of their services you'd like to take advantage of. There isn't any one fits all. It's sort of like if you've seen one billing company in a practice, you've seen one because everybody has different goals and different challenges that they'd like to have to help with their practice. So keep that in mind. Also your RCM provider, they should belong to a trade association, somebody representing the revenue cycle management industry, just like you take time to be a professional in your association. You want to make sure that you have someone that is keeping up to date with what's going on. They have an association that helps them with what's going on in Washington, what's going on with the Medicare rules and regulations. As you know, even in your practice, it's hard to keep up with everything. So you want to make sure that your RCM company belongs to an association that's accredited. They should also, there's several different accreditations that are available in the industry. HBMA, which is the Healthcare Business Management Association, which has been around for 25 years. I was one of the first five presidents of that association many, many, two decades ago now. They have a great compliance accreditation program. And as we all know today with the OIG's activity and Medicare and Medicaid, looking at everybody under the microscope, it's very important that you have a company that does have a good compliance accreditation program. Also, the provider should maintain the appropriate errors and admission coverage. There's going to be errors in many cases. You know, it's so complex today trying to keep up with all the rules and regulations. Nobody is going to have a commission error, but sometimes there could be an omission. So you want to make sure you and your practice are covered. The better companies in the industry all carry errors and omission coverage. So you should make them prove it to you so that you don't have to worry about any errors that may occur over your relationship. And then we'll talk a little bit too more about reports. But you know, you just, you want to take a look at their reporting package. A lot of the companies will say they have robust reporting, but we'll talk a little bit about that. You know, you need to be able to at least duplicate what you're getting for your practice now and see what they have to offer that maybe your current system doesn't allow. Because many companies have bolt-on reporting programs that run on top of the practice management software. Either you have or they have, and it can give you a whole plethora of reports that are very informative. I mean, I always look at, I don't want reports, I want information. So we'll talk a little bit more about that too. Do they have the proper licenses and certificates based on the state they're located in? It isn't widespread yet, but here's an example of some things that are happening in our industry. Arizona and Maryland require different licenses. Like Arizona requires that they're also a licensed collection agency, even if they're not doing patient collections. Florida now has a requirement that requires a submitter ID. New Jersey requires you register. This registration in New Jersey, all it means is that you're paying the fee to the state of New Jersey so that you can call yourself a billing company. But one thing to keep in mind, if you do service the Medicaid population in your practice, more and more states are prohibiting a billing company from charging a percent of collections related to the Medicaid collections. So what has to happen if you're in one of those states where it's disallowed right now, instead of them charging a percent of collections, which is the most popular model we see these days, they would have to say, oh, okay, for every Medicaid claim, I need to charge you X number of dollars per claim, regardless of whether it's collected or not, because of the state's requirements. And we have to sort of keep up to date on these because people keep adding different things in, and these rules and regulations change all the time. Also, you know, you always want to get quotes from multiple companies, you know, just like when we're out maybe looking for a car, you know, we may go to a couple different dealers to get a price, because the amount of money that they're going to charge you can vary. Why may it vary? Because it depends upon how much automation that company may have. As we all know, AI, artificial intelligence, and robotic process automation is starting to come into our industry now, and some of the larger companies can afford to invest in that, thereby cutting their labor costs, you know, and allowing that to pass it on to the customer. So you know, you could find variations in what cost or how they're charging you. I do have a slide here at the end that will explain to you how most companies charge and what you should look for. You may want to make a site visit. I'll talk about why you should do that right at the end of our presentation, too. And then you need to decide, do you want to do all the footwork, or do you want to hire a consultant to help with your search? You know, consultants usually know more companies, can point you in a different direction, but you know, if you have the time to do it yourself, that's fine, too. So let's take a look at the checklist. You know, some important things. And this presentation is being recorded and will be available, so you don't have to make copious notes right here. You'll be able to pull it back up on the site, as I understand, from Jessica. So I included this in here, and you'll be able to access it and make sure that you look at these different bullet points during your search. So you want to know how long they've been in business. That's an important thing, you know, because there's startups all the time. There's people that, you know, maybe have been around for less than five years. It doesn't mean they're bad companies, it's just you want to understand what is their track record, what is their expertise. Are they privately, publicly owned? Why is that important? Well, a privately owned company, the owner is the one that you're probably answering to. I've worked in both. I worked in a privately owned medical billing company, and then we took the company public. And that just changed the whole dynamic when we were public. I mean, because we were not only answering to our clients, we had to answer to our shareholders and to our investors. It doesn't make it a bad thing, but there is a different dynamic dealing with a public company versus a privately owned company. Again, I mentioned it before, but it's so important I put it back again. You want proof of their errors and omission insurance. Who are they using? How much coverage do they have? Any good company should be able to provide you with their certificate of insurance. And do they have a real compliance plan? You know, I'm sure your practice has a compliance plan and you take it serious. You want to make sure that the billing company does. I'll tell you right now, not all of them do have a real compliance plan that they participate in and make sure that they're keeping up to date. Now HIPAA compliance is another important thing too. I find that most companies are very HIPAA compliant, they're protecting information in our companies, but you also want to inquire and make sure that they have those certificates to prove that they are HIPAA compliant. Do they have a strong data security plan? As we all know, people are getting hacked and, you know, what are they doing to prevent themselves from hacking into your patient's information? I know we can't prevent every hackable instance, as they say, because as soon as we think we have things blocked and configured, somebody thinks of a way to breach that. But you want to at least make sure that they're trying to make sure that your patient's data is secure. How about a disaster recovery plan? This is important. You know, what would happen if their office would burn down? What would happen if their systems would get destroyed in a flood? A lot of people say, well, why does this matter? Well, a couple of reasons. One, I had my office burned down back in the 90s. We were in a building and someone actually torched their business in the same building and it came into our office. We were lucky because we had backup computers. This was back in the 90s, so it wasn't up in the cloud, there wasn't a cloud then, but we did have backup extra systems in one of our sister offices. But what is their plan? Also, we find, you know, during Katrina, whoever thought you'd have to worry about a disaster recovery there, but a couple of the members of HBMA, their computer systems ended up in the Gulf of Mexico. Now because of cloud computing, that isn't a problem anymore, but you just never know what the, so make sure they do have, inquire about that. Will they use your practice management system? You know, that's a possibility instead of them saying, you have to use our system. If you already have your system in place, you want them to come in and use yours. Just check with them. What's their experience? Do they have other clients that also use your same PM? How often have they used it? Very important. Now be careful. A lot of people say, oh yeah, we can do anything on any system, but you want proof that they can. A lot of employers say, hey, tell me five clients that are on this system that you're using to service orthopedics in our area. How many clients do they have in your specialty? You know, I just want to caution, if they say, oh, we have 20 different specialties, that's a little bit challenging, I think, to keep on top of everything. I'm not saying that a company has to have one specialty only, but the more specialties they have, the harder it is to keep up with the rules and regulations as they change. So you want to know, do you want to be the only orthopedic specialty practice that they have, or you want to talk to some of the people that they've been servicing for a while? That's your choice. You know, my choice, obviously, would be to make sure they have experience in your specialty. Does it matter to you if work is done onshore or offshore? I don't think it should matter to you, but if it does, you want to inquire about this, because many billing companies do have a portion of their business where they may be using a partner that's an outsource partner. There's a lot of reasons for this, obviously, because of cost, because of a lack of trying to find employees in the United States, especially since COVID, we've been struggling to be able to find people in the RCM business. so it isn't that you're just doing, you know, doing it to try to eliminate jobs in the United States. What's happened over the years, it's harder and harder to find RCM employees. And some of you may even realize this from challenges you may have in your own practices. Again, I mentioned what other specialties do they bill for? Uh, it's very important because I think if they have a whole plethora of specialties, I don't know how they could possibly keep up, uh, on your specialty and the requirements. Uh, what are the size of the groups? How many are your size? You know, if you have 20 physicians in a group and their largest physician group is five, that may be a challenge. If you have 20 physicians in your, five physicians in your group and their smallest group has 50, that may be a challenge too. So, uh, there's no right or wrong answer. You just want to make sure the company sort of can mirror what it is, uh, close to your size. And then what states are they located in? As we know, I mean, I'm in Pennsylvania and we have four Blue Cross and Blue Shields in our state. So, you know, knowing how to build Blue Cross and Blue Shield in Pennsylvania, I mean, it's complex because, you know, Independence Blue Cross wants different things and Highmark wants different things. Capitol Blue Cross wants different things. Northeast wants different things. So if they don't have any other clients in your state, doesn't mean you wouldn't choose them. It's just, they're going to have a learning curve to find out about your payers. So, uh, that's why you're going to inquire about what states are they located in. Um, how many clients do they have in your state? We talked about that. What client's been with them the longest? If they've been in business for 10 years, do they have somebody that's been in for 10 years? Uh, you know, that would show you, hey, probably a quality company. People have been pleased with them. Uh, ask for five references in your specialties with similar volumes and ask for five references in your states. Why do I say five? Anybody can give you one or two. When I go for references, I want five. Even in some instances, I sometimes say more than five. But, um, my rule of thought is if they can't give you five good references of your volumes, your state, uh, that's okay. But you just have to be aware of that. Uh, obtain examples of the reports they will and can't be provided. You know, everybody says we can give you every kind of report that you want, but you want to give, get specific examples of the reports that are important to your practice. And I know if we have, every practice we have on this call probably looks at things differently. Some probably wants RVUs. Some probably wants physician productivity. Some probably want to see referring physicians. You know, some want to see referring physicians by the insurance that they're sending you. Uh, whatever it may be, make sure they can show you ahead of time rather than just, they say, oh yeah, we can provide you with that. Ask if they charge extra for custom reports. Um, is it included? Is it extra? Who will be your contact in the RCM company? Are you going to be talking to, you know, is there a dedicated practice manager in the company? Uh, just find out who it is that you can go to, uh, when you have a question. And then what's the startup time requirements? You know, if a company comes in and says, oh, we can start doing your billing tomorrow. Oh sure. They can probably start doing it tomorrow. You won't see any cash for a good while, but they can probably start, but let them know what the timeline is to where you can get your cashflow back to normal. You know, is it a 30 day, 60 day, 90 day startup? Uh, again, there's no right or wrong answer. Uh, you just want to make sure it's right for your particular practice. Uh, do they reconcile to your monthly bank statement if that's important? You know, something you can ask them if that's on your list of things you want to have happen. What's the contract term? Is it one, two, three, five years? Uh, can you see a sample contract so that you can review exactly what their expectations and your expectations may be? Uh, how many patient statements will they send? That's important. Can they, do they do paper? Do they do email? And do they do text? All three of these are popular ways of getting statements to patients now. And then again, who pays for the postage? Something you may want to ask. Uh, if they don't use your system, will they allow you to access their system? You know, um, I don't know why you would want to access it, but, uh, just a question to ask. Some people like to access it to see, uh, take a look and see what's happening with the patient's account. But, uh, it's, it's not a necessity, but again, on your list early on, what do you want to have happen? Put it on your list. Uh, where were your patients remit their payments? You know, the, do they want the checks to come to your office? Do you want them to come to your office? You want them to go to their office? Do you want them to go to a lockbox? Uh, and then they, any company you should have a patient portal available for payments, because today, if I can't go online and pay a bill, uh, you may not get paid for me. I mean, some of the, my, my son and his friends, they don't even have checking accounts. If they can't do online payments, you're not getting paid for anything. So make sure any vendor that you select has the availability for online payments. Uh, are they going to answer your patient inquiries? If they are, what hours are their phone answered? Uh, do they provide a voicemail option so that if somebody calls in the evening, they can leave their question there? Uh, can patients email concerns and questions? Again, these answers to these questions will be based upon what your expectations are. There isn't any right or wrong answers to these three. It's what's right for you. But there are some, um, you know, just make sure you know ahead of time, because if they say, oh, we only answer the phones till, and I'm just using this as an example, three o'clock in the afternoon, and you want them answered to six, uh, you don't want to get in an argument about that after they're on, you're on board. You want this established ahead of time. Uh, do they require lockbox? If they do, who pays? Uh, and if you want coding, make sure, do they have certified coders on staff and have them prove to you that they're certified coders? Because, uh, if coding's an requirement that you want, you want your coders to be certified in your practice, make sure you're finding a company that has the certified coders you want out there. Can they obtain electronic interfaces? If you're, if this is applicable, and in some instances, if you do a lot of hospital work, the hospital may provide you with the patient demographics, um, can they interface and get that automatically? If that is applicable in your practice, if it isn't, you don't have to worry about it. Uh, will they interface with your EMR? If they're going to use their practice management system, can they access your EMR and have it load directly in? If that's something you'd like to have happen, you want to check with them. Are there startup fees? Some companies do start up, uh, startup fees. Some have monthly minimums, so you want to make sure that you know about that ahead of time. Uh, do they provide, provide enrollment services? Uh, some practices are struggling with this, so they'd like the, them to do it. It's fine. Uh, how are they going to charge for? What will cost you? And you want them to take over and work out your current AR. Uh, a lot of times, some companies will, some companies won't, so you want to make sure that you find this out before you make your decision. Uh, and then how do they charge? Uh, most companies do still charge a percent of collections. Uh, however, some charge per claim based upon the fact that they can't charge percent of collections for Medicaid. Uh, do they have a monthly minimum fee? Some companies require that. Uh, and do they have a hybrid where, uh, yeah, we're going to charge a percent of collections on these claims, but we're going to charge, uh, per claim on this. Uh, we're going to have a, you know, so just find out exactly, uh, what it is and make sure that you have them put this in writing ahead of time. Uh, do they take a fee on collection agency recoupments? We always did in our company because we did all the work, and then even though the collection agency was successful, you know, we, we took a percentage of that, but if you don't want that to happen, it needs to be laid out ahead of time. How will they bill you? Some billing companies bill you on a weekly basis, some twice a month, some monthly. Uh, some of them require that they can access your account and take it out directly, so you want to find out what is that requirement. And then for fees, you want them on a separate page, and we talked about this percent claim, give an example of the calculation, uh, are forms and postage included, or is it additional, uh, are there additional fees for the prior AR? If we were ever forced to take over prior AR, we did, but we obviously had to charge a much higher percent for that collection. You want that on paper and laid out ahead of time. Uh, if they're going to do refunds for you, how much are they going to charge you for the refunds? Uh, provide enrollment, are they charged hourly or per application? Those two are in the industry right now, and then are, are there fees for bookkeeping, payroll, and accounting if you want that? Uh, I talked about a site visit, so you can access this later to see where will the work be done. You want, may want to go there, you may not want to go there, okay? You can, you can Zoom there, uh, but you do want to know the managers, and if you're requiring coding, you want to talk to the coders, uh, you want to talk to who's in charge of customer service, you want to talk to their compliance officer, obviously. Uh, so these are some ideas, and the site visit doesn't have to be done in person, it can be done on Zoom, but I wanted to give you a little checklist here of what you need to make sure you check, uh, before you make your final decision. And then lastly, um, I just, you could sign up for my free weekly success strategies, uh, at my website right there. Also, I want to offer, if you have a question, uh, because you didn't want to bring them up today here, you can email me, and there's my email address right there. Feel free to email me, and I guarantee you, I'll answer your question within 48 hours, and if I don't know the answer to your question, I probably know someone that does. So, uh, good luck if you're out searching and shopping for a company, and I hope this, uh, information has helped you, and again, as Jessica says, this will be posted, you can come back and refer to it in the future if you need to. Awesome, thank you so much, Dave. Um, before we wrap up, um, we do have a couple of folks here from HBMA who, um, Dave referenced at the beginning. They have a, um, a directory of sorts, so if you're not sure even where to start from your revenue cycle management perspective, um, I believe Haley's going to jump on really quick and share her screen so she can show you how you can use that tool. It's free. You don't have to be a member or anything. You just go on their website and use it. Hi, everybody. My name is Haley, and I am the Director of Administrative Services at HBMA, so I'm just going to walk you through really quickly how to start looking for a, uh, billing account. So, if you go to hbma.org, um, we have a lot of resources available for you, but the one that you're interested in today is going to be find a medical biller link underneath our resources tab. Here, there are two options for you to find a medical biller. The first is our biller search tool where you can use if you have a name of a billing company that you're just trying to verify or if you have a zip code, a state, a specialty, um, or if you only want certified billers. So, just to give you an example, let's say I was looking for a biller in California. Um, we have all of our members, um, showing in this search. So, as you can see, some of our members do have, um, two seals here. The round seal is the CHBME, um, which is our certification, and then the square is the, uh, compliance accreditation program that we run through a partner of ours, um, that is specifically, um, aimed at compliance for the full company. So, the CHBME seal is for individuals and the, um, accreditation, um, feel is for company accreditation. So, that's just kind of an easy way if you're looking to, um, contact billing companies. The other way to search is going to be our RFI tool or request for information. So, in order to use this tool, you do have to create an account with HBMA, so you can create a free non-member account right here. Um, just fill out your basic information and once you're done, you will be taken over to our, um, RFI tool. So, let me give you an idea of what that looks like. So, here I've already created a profile, so you will see some of these things already filled out, but, um, the RFI does go over your specialties, so you can select as many specialties as you support, um, your size of provider of greatest interest, um, do you have errors and omissions insurance. So, basically, all the questions that, um, well, most of the questions I should say that Dave just went over will be on this checklist so that you can, um, make your specifications here, and once you're ready, you can hit submit RFI program data. An email will be sent out to all of our members who are on this list who meet your, uh, requirements, and then they can go ahead and start reaching out to you. So, um, this is a little bit, the search for biller tool is if you want to reach out to them, the RFI tool is if you want them to reach out to you. So, you can do both, um, but either way, um, you can get in touch with our billers. Thank you so much, Haley. All right, um, we have one more minute left. If anybody has a question, I will be monitoring the chat, so feel free to drop it in there. Um, otherwise, everyone will get a notification with the, um, link to where the webinar recording will be, and, um, definitely reach out either to myself, to Dave, um, if you're interested in learning more about HBMA or have a question for Haley about the tool she showed you, I can always connect you with them as well. So, thank you so much, everyone, for joining us today, and, um, look forward to seeing you the next time around. Thank you.

medical billing company

outsourcing

vendor selection

compliance

data security

healthcare practices