Turning Problems into Profits

What You Need to Know about Outsourcing

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Do you need help with your billing but have concerns about turning it over to an outside company?   You are wise to be cautious!  We get frequent calls from optometrists who have had bad experiences with outsourcing–for a variety of reasons.

  • Medical billing companies don’t understand the hybrid world we live in that combines medical and routine vision.  Some companies hire employees with little experience and don’t give them the training and support they need to do the job well.  Some companies spread themselves too thin, taking on too many clients without the resources to adequately devote to each account.  Some companies outsource their accounts to off-site employees–some of whom are home-based and some who are located overseas, making it difficult for billing companies to control the quality and consistency of their work.

There are some things you can do to help protect yourself and reduce frustrations!  Recently we came across a great article published in AAPC’s The Coding Edge, a healthcare magazine for medical coders and billers.  The article was called “Ask the Right Questions Before Outsourcing Your Billing.” *  Here are the questions they suggest doctors ask billing companies before signing up for their services–and our answers to the questions!

1. What credentials/experience does the billing service have? 

  • Optometric Billing Solutions has been in business since 2005.  The company is owned by Brooke Armstrong and Branda Barton, two sisters with degrees in Healthcare Administration, who worked their way through college working as insurance billers at an optometric practice.  Before starting OBS, both managed large practices.

2. Does the billing company have experience in your specialty?

  • OBS does nothing but optometric billing, and we are recognized as experts in the field.  We understand the unique demands of optometric billing that require a knowledge of both medical and routine vision.  We serve practices in thirty states, so we know your insurance payers, how to file for maximum reimbursements, and how to handle their denials and appeals.  Because we specialize, you benefit!

3.  What kind of training does the staff have and receive?

  • The company currently employs over fifty billers, a third of whom have received their medical coding and billing certification.  All new billers at OBS go through a rigorous four week training program designed to make them experts in the field of optometric billing.  They must also learn very specific, proprietary billing processes to ensure accounts are worked correctly, efficiently, and timely.  After classroom training, all new staff members work with a mentor for another four weeks.  Mentors continue to monitor their performance and answer questions as they begin to work for our doctors, and new staff do not finish this training process until they can demonstrate a 95% accuracy rate or higher.  But to be fair, staff training never really ends.  All billers at OBS are assigned to a senior billing manager for continued help and support, and each month we provide in-service education to keep our billers abreast of changes in the industry. We continually invest in our staff’s training because we know they are the backbone of our company’s success!  Finally, you need to know that unlike other companies, all of our billers are located in-house.  We will not out-source your account to off-site or overseas staff where it is difficult to control consistent quality.

4. What is the procedure to protect the privacy of information?

  • We log on to our client’s own system to file and post claims, so protected patient information never leaves their office!  Rather than using email, which can be compromised, we request and receive information from our clinics through a secure Internet portal.  All employees receive training in HIPPA compliance and sign a confidentiality agreement.

5. What are the company’s technical capabilities?

  • We live in a world of technology!  We currently work in six of the industry’s leading practice management softwares:  OfficeMate, MaximEyes, Revolution EHR, CompuLink, My Vision Express, and Crystal PM.  Before starting OBS, Branda worked as a practice management software consultant, so she has a unique working knowledge of how softwares work and utilizing them to their fullest potential.  OBS currently submits claims through the most popular clearinghouses, including TriZetto/Gateway, OptumInsight/Ingenix, Emdeon, and Apex.

6. How does the biller handle claim changes?

  • If we encounter a coding error on a claim that will keep it from processing, we send the claim back to the doctor for review. OBS will never change the doctor’s CPT or diagnosis code without the approval or direction of the doctor. If the error is simply clerical in nature–missing IDs, incorrect insurance, incomplete demographic data, etc.–OBS will correct the information and file the claim.

7. What type of financial reporting does the billing company provide?

  • Because we work directly through the clinic’s own software, the practice always has complete, real-time access to their insurance data.  There is no delay in waiting for an outside billing company to send information back to you.  Each month we compile reports on your AR trends and your optical staff’s errors in collecting on VSP glasses.

8. How is the billing company’s follow-up practices?

  • OBS works unpaid claim on your AR report each month, and we’re experts at filing appeals if payers have processed the claim incorrectly.  Our goal is to collect every penny from insurance companies that your practice deserves.

9.  How much will everything cost?

  • Our fees are based on a percentage of your insurance allowables, not your billed fees, which is fairer to our clients since the latter requires you to pay on write-offs you can’t collect.  NOTE:  Practices need to be careful when comparing billing company fees to make sure they are comparing apples to apples, i.e., full billing services (auditing, filing, posting, AR, and follow-up appeals) vs claim submission only.  Companies who quote fees significantly below the industry average are usually quoting fees for claim submission only and they may charge add-on fees for each additional service.   A la carte billing can be expensive, so make sure the billing company’s fees and responsibilities are clearly outlined in a contract.

 

The staff at Optometric Billing Solutions are experts in our field, and we only serve optometrists. We know your profession and your payers, and because we specialize, you benefit.  We have a proven track record in maximizing insurance revenues, and a long history with each of our clients.  We still serve the first four clinics we started business with in 2005, and would be happy to provide you with references from our clients.  If you have questions, we invite you to call us at 877.727.3695.   We’ll be happy to discuss our services with you in greater detail and help you determine if OBS would be a good fit for your practice!

 

*Online link to original article: Ask the Right Questions Before Outsourcing Your Billing