Guide to Using an External Gastroenterology Billing Service Company
Questions to ask when evaluating a third-party billing vendor.
Running a successful gastroenterology practice can be complex, even daunting. While focusing on providing the highest quality of patient care, you must also work to ensure your practice is performing well financially. There are many contributing factors to the bottom line, but your gastroenterology billing represents the biggest opportunity for success—or conversely, if not handled properly, failure.
For various reasons, many practice owners don’t have proper visibility into their billing and collections. You may simply “not have the time” amidst your busy patient schedule. Or you trust it’s in good hands with your billing staff, relying on the information they provide. Though it may seem you’re doing fine, chances are there’s an opportunity to improve your financial performance by working with an external gastroenterology medical billing service.
Streamline Your Gastroenterology Revenue Cycle Management (RCM)
The best medical billing companies provide deep expertise in revenue cycle management (RCM), typically beyond what in-house staff can provide. An external billing company can help you improve operations and gain greater peace of mind.
Benefits of a Third-Party RCM Vendor
Working with a trusted gastroenterology medical billing company offers a myriad of benefits, including:
- Greater Financial Visibility. Working with an external billing vendor for RCM may improve your understanding of the revenue cycle by working with experienced revenue cycle and billing specialists.
- Security. Successful revenue cycle management companies have HIPAA-compliant and secure medical billing processes in place.
- Regulatory Compliance. A good gastroenterology revenue cycle management vendor stays current with rules and regulations, helping your practice keep up with changing conditions.
- Increased Efficiency. In addition to reducing internal overhead, utilizing experienced gastroenterology medical billing and coding specialists may help you receive more of what you’re owed.
- Reduced Costs. Offloading your RCM to a gastroenterology billing company could save you time and money associated with in-house operations, thereby increasing the profitability of your claims.
- Less Capital Expense. RCM outsourcing enables you to shift investment from a capital expense (buying and owning) to an operating expense (paying for a service), giving you more flexibility, scalability and control of your cost.
Evaluating the Best Gastroenterology Billing Companies for Your Practice
Once you’ve decided to use a third-party billing vendor for RCM, it’s critical you choose the right gastroenterology billing solutions provider. Not all billing companies are created equally and, although no vendor or system is “perfect,” some are better suited to your business and requirements than others.
At a minimum, you’ll want to confirm your vendor offers:
- A dedicated team. Billing specialists that track and manage your claims end-to-end to help you get paid what you’re owed.
- Robust technology. A proven practice management platform with tools and features to streamline the billing, collections and payment process for both the front and back office.
- Timely claims submission. A process where claims are created, “scrubbed” and submitted to payers promptly.
- Denial and rejection management. The ability to handle the re-work for denials and appeals for rejection to help obtain payment.
- Detailed reporting. Comprehensive real-time reports that provide visibility and transparency into your billing performance.
Questions to Ask a Possible Billing Company
When evaluating gastroenterology billing companies, be sure to ask some, if not all, of the following questions:
- What services do you offer?
- What is your pricing model?
- What customer support services do you provide?
- Will I need to upgrade my technology to work with your company?
- What is your process for handling claims and submissions?
- How does your company handle denied, unpaid and partially paid claims?
- How do you handle adjustments and refunds?
- What are your average performance metrics (e.g. gross and net collection ratio, clean claim rate, denial rate, rejection rate, A/R over 90, Days in A/R)?
- How do you store information? And how do you protect confidential personal health information?
- How is communication between my practice and your company handled?
- Is your team trained in HIPAA requirements, and do they receive ongoing coding training?
- How do you stay current on federal regulations and coding rules? Can I look at and audit my practice’s claims information when I want to?
- Can you provide testimonials and references from your other clients?
Step Towards Better Performance
As you consider your options for managing your gastroenterology billing operations— in-house or outsourcing—remember that revenue cycle management is complex, requiring deep knowledge and expansive experience. Add to that the intricacies associated with gastroenterology, and it’s imperative you have an experienced team dedicated to your practice and specialty.
As a practice owner, you can’t afford to leave money on the table with subpar medical billing and collections. Engaging the services of a proven, trusted RCM services provider can have a significantly positive impact on your practice’s financial performance and overall success.
Interested in learning more?
About Veronica A. Diaz, MD
MEDICAL DIRECTOR OF ORTHOPEDICS AT MODMED
A practicing orthopedic surgeon, Dr. Diaz works with clients to help develop ModMed's orthopedic platform. In private practice for 10 years, she treats degenerative, traumatic and sports-related conditions of the shoulder and upper extremity, emphasizing arthroscopy to manage rotator cuff disease, shoulder replacement, and reconstructive procedures for the elbow, wrist and hand.
She graduated from Princeton University with a degree in molecular biology, earned her medical degree from the University of Florida, and completed her orthopedic surgery residency at the University of Miami Jackson Memorial Hospital.
Dr. Diaz is a member of the American Shoulder and Elbow Surgeons and the American Society for Surgery of the Hand and an active fellow of the American Academy of Orthopaedic Surgeons. She holds several clinical advisory and consulting positions in healthcare and health technology.