Medical Billing

How to Choose a Medical Billing Company: Red Flags That Cause Concern

By: Allison Scheier, Client Relationship Manager

Are you a medical practitioner or administrator looking for the right medical coding and billing solution to make your business thrive? There are so many potential partners in the market; it can be hard to know whom to trust. Before making any decisions, consider the following:

1. What is the true value of the service?

Claims processing is the core of revenue cycle management, but there is so much more than just billing claims and posting cash. Seek a billing partner that offers a breadth of services. Look for a billing partner that offers assistance with credentialing, financial clearance, and coding audits and education. You can leverage a company’s knowledge for your own benefit.

Red flag: Ensure that a representative can fully explain the company’s offerings. If a salesperson seems confused, more than likely you will be, too.

2. Read thrice, sign once.

Think of signing a contract like cutting a piece of wood. Rather than “measure twice, cut once,” with contracts you should “read it, read it again, and then read it once more, before putting pen to paper.” Make sure there is a well-defined scope of work that states where your practice’s responsibilities end and the billing company’s begin. Contracts should also contain conditions for payment and termination. Look for clear statements regarding a potential partner’s limits of liability, the length of the contract’s term, and acceptable ways to end the partnership. Don’t neglect the fine print!

Red flag: Look out for hidden fees. Some billing companies market low prices, but charge exorbitantly for add-ons. Even if you don’t need additional services now, they should be clearly labeled for future reference. Also, watch out for companies that are unwilling to answer questions or will not negotiate terms. Medical coding and billing needs are different for every practice, so if a company pressures a “one size fits all” solution, it may be time to reevaluate.

3. Don’t why away from data.

Today, everything is digital. You need to know what protections are in place to secure your patients’ information. What software is used? Is it compatible for compliant integration with your current systems? Once you have established that your data is secure, make sure it is easily accessible. I recommend a cloud-based software so you can access your data from any device with an internet connection.

Red flag: If there is minimal mention of employee HIPAA compliance training, data breach protocol, or cloud-based flexibility, put your pen down.

4. What reporting comes standard?

It is a good sign if a self-service, custom dashboard is available, or if a billing company is capable of generating custom reports. Clear, comprehensive reporting can reveal valuable insights into your practice’s health and your patients’ needs. There is immense value in data analytics, so find out what reporting is included and if the level of interpretation will affect the price.

Red flag: Beware of companies with limited reporting capabilities or excessive fees for simple data pulls, such as charge logs. It should not cost thousands to analyze what makes your practice tick.

5. What support is available?

It is natural for questions, and even issues, to arise. When they do, who are you going to call – a customer service line with an automated message? You want to talk to someone real who can research and address your concerns in real time, someone who knows your business. Be sure there is a dedicated point of contact in case of operational issues or a question about an invoice.

Red flag: Automated systems can take you to a voicemail box that is rarely checked. Make sure you have a dedicated point of contact for questions and concerns. In other words, ensure your valuable feedback is heard. Additionally, if there are no opportunities to meet with your billing partner to review your practice’s performance (for example, a governance meeting), it may be a sign that the company is not willing to be transparent or provide support.

I have often seen potential clients struggle to relieve themselves of contracts with billers who they realize do not have their best interest at heart.

If you are unhappy with your current biller, consider switching to the team that works toward your success… and never “press 1 for service” with an automated attendant again. At Saisystems Health, our team streamlines your operations to increase collections through compliant and responsible strategies. We only succeed when you do, so there’s nothing to hide in our agreements.

Contact Sam to compare your contract today at or 203-567-5232.

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