How To Choose The Right Billing Partner For Your Practice?

Running a medical practice today feels less like practicing medicine and more like managing administrative tasks and a constant stream of financial issues, RCM operations, and the most difficult of all - claim denials. You didn't go to medical school to worry about claim denials, coding errors, or chasing down insurance companies for payments that are rightfully yours. Yet, that is what most healthcare professionals have to do these days. 

Luckily, every problem has a solution. And in this case, outsourced healthcare RCM services are the solution that can save you from a lot of issues. However, choosing a good company for these services is a problem of its own. The wrong choice can lead to opaque reporting, lost revenue, and even compliance risks.

That’s why we have created this detailed guide on how you can choose the best billing partner for your internal medicine practice. So, let’s start.  

The Metrics That Matter

Before we can discuss how to choose the best billing partner for your practice, it is first important to mention what to evaluate in a potential partner. If you don’t know what to measure, your revenue is sure to go downhill. Before you interview a single billing company, you need to know what "good" looks like. Many agencies will promise you the world, but data tells the true story.

Denial Management is Critical. The most alarming statistic in medical billing today is that 20% of all claims are denied, and 65% of denied claims are never resubmitted. That is money you have earned but are voluntarily walking away from because no one has the time or expertise to fight the insurance payer. A strong billing partner treats a denial as the start of a process, not the end. Since 90% of claim denials are preventable, your partner should have rigorous front-end scrubbing to catch errors before they ever reach the payer.

Benchmarks for Success

So, what should you evaluate in a partner? Well, a good practice is to ask for their average performance metrics and compare them against these industry standards:

• Net Collection Rate: You should aim for 95% to 99%. If a billing company is consistently below 95%, they are leaving your money on the table.
• Days in Accounts Receivable (A/R): A healthy practice should see an average of 30 to 40 days. If your current A/R days are creeping above 50, your cash flow is being strangled.
• Denial Rate: The denial rate of any potential billing company should always be below 10%. It is good if it is below 5%.

Specialized Medical Expertise

The next most important thing to look for in a billing company is expertise. Consider, when choosing your billing partner, whether or not the company has expertise in your specific medical specialty. For instance, if you have an internal medicine practice, you must choose a company that offers highly specialized medical billing and coding services for internal medicine practices. Yes, generalized billing vendors are cheaper, but in the long run they will end up being in loss. 

Similarly, surgical practices need billers who understand bundling rules, while mental health providers need experts in behavioral health parity laws. When you evaluate a partner, ask for case studies or references specifically from your specialty. A partner who understands the clinical reality of your daily work will always be more effective than a generalist. To test them, give them a scenario of a complex disease and its treatment, and ask them how they will bill it. If they get it right on the first try, they are the right choice. 

Experience and Local Presence

Continuing from our last section, you must always try to select services from a locally present billing company. Try to find billing and coding vendors that have a local presence in your city and state. Don’t go for companies that have offices in other cities or states, because in most cases, they are LLCs and operate from other countries. 

Also, look for companies that have at least 5 years of experience in internal medicine billing. General experience does not count. Plus, ask them about the experience of their billers. Usually, if their billing and coding experts have 5-7 years of experience, you can rely on them. 

Questions to Ask Potential Partners

To cut through the sales pitch, ask these specific questions:

• "What is your current first-pass acceptance rate?" (It should be above 95%.)
• "How do you handle denials? Do you have a dedicated team for appeals?"
• "What is your average hold time for patient billing inquiries?"
• "Can you guarantee that my work will not be subcontracted to unvetted third parties?"

Wrapping Up

That’s it. After reading this guide, you must have all the necessary information to choose the right billing partner for your internal medicine billing practice. Do not settle for a vendor who just processes paperwork. Try to find a partner who is genuinely an expert in medical billing. 

By doing this, you can save a lot of pain and issues in the long term. So, start evaluating potential partners and outsource your billing operations.