CODING CLASS: Outsmart Your Outsourcing Issues With 13 Questions

Choose a billing company -- or not -- with confidence
So many health information management professionals feel that billing is the most frustrating part their jobs -- so they decide to leave that chore in the hands of someone else. While there are considerable benefits to outsourc-ing your billing, you should also consider the risks and clarify important points before you hand claims over to a billing company.
Start-up costs to establish an in-house billing system can be incredibly high -- so enlisting outside help is often an attractive option, says Jim Hall, with Rehab Management Services in Cedar Rapids, Iowa. You have to find the hardware and software to suit your needs, hire someone "with the savvy to engineer that software," hire full-time employees to do the billing and get those people the training they need to do the job well, Hall explains.
When you outsource your billing, however, those components are already there, Hall says. Plus, you don't have to worry about potentially having to scrap your initial billing system if you outgrow it.
How it works: Many billing companies charge based on a percentage of billings, a percentage of collections, a flat monthly fee or some combination thereof. "Providers should be aware that (percentage payment arrangements) will take them outside the protection of a safe harbor to the anti-kickback statute since aggregate compensation will not be set in advance," notes attorney Linda Baumann with Reed Smith in Washington, D.C. Although these arrangements aren't illegal per se, they could raise red flags with the OIG, she adds. If you decide to go with a percentage arrangement, take special pains in working out the details and incorporating compliance safeguards for your facility.
Protect yourself: One way to avoid trouble with the government with regard to your billing company is to "make sure you have a reputable billing company that understands compliance," insists Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions in Brick, N.J. That means your billing company should have a compliance plan at the ready, Cobuzzi says.
Safeguard: If you pay the billing company based on a percentage of collections, there's a chance billing staff could be tempted to upcode in a ploy to boost payment. This is a huge problem that providers must be certain to avoid, Cobuzzi notes. Put it in writing that the billing company is not allowed to change the diagnosis you've provided, and must consult with you on how to proceed in the event of a denial for medical necessity, she counsels.
The key when signing on with a billing company is to not make any assumptions about how the process [...]

- Published on 2004-06-10