Choosing to outsource billing is a big step for a surgery center. The cash that comes through your billing office funds your employees, your suppliers, and at times the owners. It takes trust to give others this work, and trust should be based on facts. Some owners sign a contract on a good sales call and find out about it a few months later. This article takes a look, in layman’s terms, at what physician owners should look at before they sign, and is guaranteed to leave you with answers, not promises.
Start With Your Own Numbers
Before you talk to any ASC billing company, know where you stand today. Pull reports for the last six to twelve months. Check your overall collections, denial rate, days in accounts receivable, and the percentage of your unpaid money that’s more than 90 days old. Pay attention to your net collection rate as well; this indicates the percentage of money you could collect that you actually collected.
These numbers have two functions. They can tell you if you do have a billing issue and provide a starting point. If a company is promising something better than it is, you can try to check it against facts. Later, it will be difficult to determine if the change was beneficial without this base.
Check That They Understand Facility Billing
An ambulatory surgery center bills for the facility aspect of a case, which is different from billing for a doctor’s office visit. This includes operation room, nursing, supplies and recovery. Payers have special rules in place for payment of these cases, such as reduced payment for more than one procedure performed in the same session, separate handling of implants and high cost supplies, etc.
Inquire about the number of surgery centers where the company provides services and in what specific areas. A team that primarily performs physician billing might not be familiar with the facility rules. Discuss their procedures for making prior requests, their billing procedures for implants, and how they follow up on requests that were made but not billed. The answers they give should be precise and clear. If they are still general, it’s a red flag.
Understand How You Will Be Charged
The majority of companies take a cut as a percentage of the funds collected for you. This is good as it only increases their income when you do. But the percentage is not the end of the story. Inquire about the cost of the fee. Some cover all costs, and others require additional fees for credentialing, patient statements, appeals, or setup. These extras can add up to a low headline rate in no time.
Ask what the fee is based on and how much it costs. Is it a percentage of the money collected or the amount billed? Does it apply to old claims that were already active prior to switching? Does it extend to patient payments as well? Always ask for the answers to be written. A slight wording change can make a thousand-dollar difference in your cost per year.
Know Who Will Do the Work
You’re not paying for a logo. You’re getting a group of people to work with you. Find out who will be handling your account, how many centers they will be handling, and whether they will be the same person every time. Check if coders have qualifications and if the coding is outsourced or performed in-house. If part of the work is being done overseas, inquire about the protection of patient data and whether the company has entered into a BAA (business associate agreement) to comply with patient health information handling requirements.
Additionally, it is crucial to inquire about the business’s employee training methods. There are changes to surgery codes and payer rules very frequently, and a good team should have a clear working plan to keep up to date.
Look Closely at Reporting
Once you outsource your job, you must still have control, and reporting is the key. Request a copy of a sample report before signing. It should display claims billed, payments received, denials and denial reasons, and unpaid claims by age. It should be sent regularly, typically once a month, and you can ask questions without having to wait weeks.
Inquire if you will have direct access to your billing system and your data. It should be possible to check claim status on your own, not only through the company. This will protect you and allow you to keep the process open.
Read the Contract Carefully
The contract is the place where promises turn into rules; read the contract slowly. Be aware of the duration of the term and its renewal. Some of the agreements are going to be renewed without any notice, and the notice period may be lengthy. See what happens if you aren’t happy. Are you stuck for years, or can you give twenty or sixty days’ notice and go?
Make sure that the data owner and your claims history are included in the contract. You should have a way to take your records, payer files, and your account information with you if you leave in a usable format. You should also see what happens to unpaid claims when you go. Money collected long after the contract has ended is being kept being charged by some companies.
Be sure to check for performance claims. Some companies will agree to goals like reducing the days in accounts receivable or to a certain denial percentage. But targets are so insignificant until they are on paper and have a clear remedy if they are not met.
Ask for References and a Trial Review
Talk to at least two or three surgery centers that already work with the company, preferably ones with a similar size and specialty mix. Ask them how fast problems are fixed, how accurate the reports are, and whether collections improved. Their answers will tell you more than any brochure. You can also compare how companies describe their process. For example, the team at doctormgt.com explains its approach in plain terms, which is a good standard to hold others to.
Another smart step is to ask for a sample review. Give the company a set of your recent claims and ask what they would change. This shows how closely they look and whether they find real problems.
Plan the Transition
Even a good partner needs time to take over. Ask how long the switch takes, what they need from you, and how claims already in progress will be handled. Make sure someone at the center is named as the main contact, and plan weekly check-ins for the first three months. This is when small gaps are easiest to fix.
The Bottom Line
Outsourcing can help a surgery center collect more, work faster, and free its owners from daily paperwork. But the benefit depends on picking the right partner and signing the right agreement. Know your numbers, ask direct questions, read the contract, and test the company before you commit. A little care now protects your revenue for years.
