When evaluating potential outsource billing partners, agencies should consider 7 key factors: 1. Define your specific billing needs to identify suitable partners. 2. Check partners' experience, particularly with your industry and payors. 3. Evaluate if partners can meet your defined needs and address issues like software compatibility. 4. Consider pricing models like per patient, percentage, or per claim rates. 5. Review contract terms regarding costs, length, renewals and other fees. Taking time to evaluate potential partners across these factors helps identify the best fit.

1. Key Factors
when
Evaluating
Outsource
Billing Partners
A CareSmart Billing eBook.

2. There are many circumstance that may
 Home Health Care
result in a medical provider, home health, or
 Hospice deciding to outsource their
hospice agency
 Physician or Medicaid billing. A
private, Medicare,
new practice or agency may want to focus
on the processes and care vs. billing at the
launch of an agency.

3. A more established providers may be
 Home staff turnover or lack of qualified
frustrated by Health Care
 Hospice staff. Sometimes, an
and reliable billing
 Physician
agency may look to outsource billing on a
short-term or emergency basis, to cover staff
transitions or an unexpected illness on their
billing team.

4. Whatever the catalyst, the decision to
 Home Health Care
outsource billing is only the first in what should
be an extensive evaluation process of options
 Hospice
available to agencies. This eBook discusses 7
 Physician
Key Factors that you should focus on as you
begin your search, narrow your choices, and
ultimately make a decision of a best fit billing
company for your agency.

5. The 7 Factors
 Critical Information You Need to Make a Decision

6. #1 – Define the Need
Many resources start their list focused on the billing
company. Before turning your attention to your search, a
key step is to evaluate your agency’s specific needs.
Taking the time to complete this step will eliminate hours,
days, even weeks from your search process. You may be
tempted to say “I just need someone to do the billing from
now on,” but by focusing on the specifics of what services
your agency needs, you can better identify those
companies that can meet them.

7. #1
Sit down with the key members of your staff or a trusted
associate and map out the services you need.
Some services that vary by billing company:
Insurance Eligibility Accounts Receivable Tracking
Coding Historical Claims Tracking
Claim Submission Audits
PPS Monitoring Credentialing
Denial Management Follow up Functions
Patient Accounting - Statements Transfer to Collection Agency
Customized Reporting

8. #1
Create a “Needs” guide using a document or spreadsheet
editor. A spreadsheet is ideal as it allows you to list the
needs of your agency in the first column and then track
the services provided by the billing companies you
research side by side:

9.  Home Health Care
 Hospice
 Physician

10. #2
Contact your state or national associations to get
recommendations of billing providers for your industry.
As you get a list, conduct qualifying phone calls
Years in business
Number of employees
Number of current clients
Capacity to take on new clients

11. #2
Note: Balance experience, years in business, experience
and number of current clients to what your needs are. A
large national billing company may not provide the
personalized service a new agency may require. Likewise,
a well-respected regional company may not be a best fit
for a large multi-state home health organization.

12. #2
Request key metrics:
DSO – Says sales outstanding
Submission and follow-up delay metrics
Billing cycle metrics
Average A/R
Reduction of payment delays

13.  Home Health Care
H O M E H E ALT H
 Hospice
M E D I C AL P R O V I D E R
 Physician
HOSPICE

14. #3
When you evaluate a billing company’s experience, you
should ask specific questions regarding their home health
and hospice billing experience. Experience with home
health Medicare and Medicaid is critical for agencies that
see these patients.

15. #3
Key Questions to ask:
How many years of experience for my specialty?
What states have you successfully billed in (key for
Medicaid)?
What private payors do you have experience with?
What type of practices or agencies do you have
experience with (start-up, Medicare certified, private
only, hospital, large franchise)?

16. #3
It is also important to ask how the company’s staff stays
up to date with terminology, regulations, HIPAA and other
compliance issues.
Lastly, with ICD-10 looming, it is critical to make sure that
not only is the billing company training their staff on the
changes, but that the software and clearinghouse they
use has been tested and passed for HIPAA 5010
compliance.

17.  Home Health Care
 Hospice
 Physician

18. #4
Now that you have determined the billing company has the
industry specific experience, use the “Needs” spreadsheet
you created in Step #1 to identify which of the companies
you are evaluating can address them.
It is likely that different companies offer different “levels”
of service. By using the “Needs” sheet you and your team
can see visually the top two or three companies that most
closely align with your practice or agency’s billing needs.

19.  Home Health Care
 Hospice
 Physician

20. #5
Technology compatibility is a key component when
selecting a billing partner. Some companies will work with
your current software, some require you to switch
software, others simply have you export your information
to them and they key it into their software.

21. #5
If your practice or agency has software, and it fits your
needs, it is important to find a company that will work with
your software. This allows you constant access to the
financials. You can monitor you’re A/R and address any
issues as they arise.

22. #5
If your agency is currently paper based, discuss with each
of the companies the option for software for your agency.
The billing company may have two or three vendors that
they recommend from experience and client response.
If the billing company includes software with their billing
package, evaluate the software as vigorously as you
evaluate the company. Ask if the software is included at
no charge, or if there is an additional fee or increase in
percentage rate.

23. #5
If your practice or agency is part of a hospital or larger
organization, you will need the ability to communicate
billing, receivables, and reporting information over your
network. Ask the billing company how they will facilitate
this.

24.  Home Health Care
 Hospice
 Physician

25. #6
There are usually three pricing models offered by billing
companies:
Per Patient
Percentage
Per Claim
Each model has its advantages and disadvantages, so it is
important that you evaluate what best meets the needs of
your practice or agency with regards to budget, business
models, and projected growth.

26. #6
There are usually three pricing models offered by billing
companies:
Per Patient
Percentage
Per Claim
Each model has its advantages and disadvantages, so it is
important that you evaluate what best meets the needs of
your practice or agency with regards to budget, business
models, and projected growth.

27. #6
Per Patient
This fee-based model charges a fixed dollar rate per
patient per month.
This model can be more cost effective as it is not tied
to the amount collected, but can also provide less
incentive for follow-up on denied claims.
With this model, forecasting billing as a budget item is
easier as the cost is usually fixed.

28. #6
Percentage
With the percentage model, the billing company
collects on the total collections. Many see this as a
win-win model as the success of the billing company is
directly tied to the successful billing for the agency. A
drawback is that potentially, a billing company will
focus only on big claims when it comes to denial
management vs. the smaller claims. However,
reputable companies work to recover all of a clients
monies.

29. #6
Per Claim Rate
With this model, the billing company charges per claim
for the submission.
There is no incentive for service to follow up on claims.
Denial management, collections, aging are additional
charges.

30.  Home Health Care
 Hospice
 Physician

31. #7
The last focus is on the terms for service. Ask to see a
copy of the Terms & Agreement once you have narrowed
the field.
Things to evaluate:
Upfront costs HIPAA Compliance
Length of contract Confidentiality
Renewal terms BAA Compliance
Additional Fees/Charges Support options

32. After focusing on these key areas, your
 Home Healthable to successfully
agency should be
Care
Hospice
identify which home health billing company
Physician
is a best fit for your agency.
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