Each medical billing service, just like each medical practice or laboratory is unique. Therefore, there is no one “best” billing company to suit the needs of everyone. The billing solution must be the correct fit for the organization in order to maximize revenues, provide complimentary technology, customer service and business intelligence.

Therefore it is a wise idea to avoid blanket claims of arbitrary collection percentages or revenue increases made by some medical billing and revenue cycle management companies. Instead, it pays to dig deeper and review specific areas of consideration for each revenue cycle management company you may be considering.

We suggest making sure that the company you chose matches your desires in the following areas:


Ability to maximize revenues

Sure, all billing services say they will maximize revenues, but how confident are you that the companies you are considering can actually do it? Take every function of the billing process as well as the people who perform the work into consideration.


Follow-up Protocols

This may seem similar to the above, but it is so important (in our opinion) that it deserves its own category. How do they perform insurance and patient follow-up functions, and how in-line are these processes with your ideal expectations? Do they follow up just based on reports or do they have more advanced technologies aimed at capturing dollars that others might slip through the cracks. Dig deep on this one.


Division of responsibilities

Look at how how much work you are going to have to do in order to work with the company or get that great rate they might be offering. With RCM companies, there can be drastic differences, and nothing is more disappointing than signing on with a company, only to find out that many of the burdens you are trying to outsource have been placed back on your shoulders! Some even ask you to submit the claims and work denials… isn’t that what you are paying them to do?!? To avoid disappointment up front, we advise walking through the entire claims cycle from start to finish to find out exactly what they will do for you and what is required on your end. Also ask about problem areas such as claims which don’t pass claim submission scrubbers, as well as denials, requests for medical records, refund processing and patient relations.



While the ability to maximize revenue is most important, you should also choose a company that provides you with a practice management system that comfortably suits your needs in a variety of ways such as appointment scheduling, data transfer, patient tracking, EHR and reporting. Systems should be highly accessible, user-friendly, and have extremely high level functionality. You may also want to make sure that the system provided can seamlessly work hand-in-hand with your Electronic Medical Records (EMR) and LIS systems both now and in the future.


Internal Structure

The internal structure of the organization should be conducive to both maximizing reimbursement and to customer service. Determine if they use billing “assembly lines”, or if they have a one-on-one or small team approach. Make sure the company structure makes sense to you and meets your expectations.


Level of Experience

It is important to note not only the experience of the company, but also the experience levels of the actual specialists, supervisors, and managers who will work on your account.


Billing Service Internal Procedures

You can often tell a lot about a billing company by their internal procedures and protocols. Believe it or not, many don’t have any. Ask what type of quality control initiatives they have in place. See if these initiatives are formalized.


Customer Service

There is not a salesperson in the world who won’t tell you that the company they represent has the best customer service. So dig deeper. Ask about policies. Do you have a dedicated contact and a backup? Is that contact actually involved in the day to day responsibilities of working with your patients and payers? Most importantly, make sure the structure of the company does not hinder your access to the specialists who actually perform work on your behalf.



Make sure that data regarding billing is available to you at all times. That means charge data, payments, outstanding claims, user notes and follow-up detail should only be a few clicks away. This level of transparency ensures that you can audit your billing service and maintain complete control over your practice.



Outsourcing your billing to an outside service can have the added benefit of creating a level of billing redundancy to make certain your revenue cycle stays on track and generating maximum income. But don’t take this for granted. Investigate levels of personnel redundancy to make sure that your billing continues to be processed properly without delay if a specialist leaves unexpectedly. Also check into redundancy related to the company’s computer systems.


HIPAA and OIG Compliancy

Make sure that your billing service has a formal and correct HIPAA and OIG compliance policy. This is essential in ensuring security for both you and your patients.


Patient Relations

Different billing companies treat patient billing and calls in different ways. Check into the procedures and tactics used to collect payment from your valued patients. They should not only be effective, but should also reflect the manner in which you want your patients treated. Also, determine how much of the patient billing process is placed upon your shoulders instead of on those of your service provider.


Workflow Changes

Will you have to completely change the way you function just to accommodate your billing service, or if they are willing to work around you.. A billing company should have options which integrate seamlessly with your processes and not require significant change or realignment.



What is the overall cost? Look at the details. What is included and what is buried in the fine print? Are things like software, training and postage included? Are there startup fees or any hidden costs? Do fees seem exorbitant or perhaps even too good to be true? Sometimes you get what you pay for (good or bad). Make sure to compare apples to apples. What good is it if you pay a billing service 2% less, but collect 10% less revenue?



Last but not least, take a look at the sales processes utilized by the various billing companies. It is often a prelude to the manner in which they service your account. Are they willing to take the time and understand your organization? Better yet, have they offered to perform an analysis of your current situation and revenue? Look for someone who seems interested in finding the right solution and not just making a sale. Chances are they will be there for you with the right advice after the sale as well… and you are less likely to be treated like a number.

We hope these tips are helpful in your evaluation of billing and revenue cycle management solutions. Please do not hesitate to contact us for a free personal consultative review and to see how PractiSource stacks up. We appreciate the opportunity to speak with you and thank you for your interest!

Ask the hard questions. Narrow the field.