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Avea Solutions Blog

3 Questions To Ask Your Billing Company In Case Of A Breakup

Feb 15, 2018 9:26:00 AM / by Greg Goode

Greg Goode

3 Questions To Ask Your Billing Company In Case Of A Breakup


In our new blog series, "Your Billing Company & You," we’ll be framing the relationship between providers and billing companies as just that…a relationship. We all have experiences in relationships, whether with friends, family, or romantic partners. Thinking of being in a relationship with your billing company is a useful exercise that can help you see them in a new light. This is relevant to all providers, whether you’re thinking of signing with a new company, maintaining your relationship with your current billing company, or considering “breaking up” and moving on to something new. Regardless of where you're at in your relationship, we’ll have some useful information for you!

“Are we breaking up?” Not every relationship is built to stand the test of time. This is as true for a marriage as for the partnership between a facility and a billing company. That's why it makes sense to determine from the start how to best go your separate ways at the end. Like an actual prenuptial agreement, this can be an uncomfortable conversation; but also like a prenup, it's one that benefits both parties. 

Below are questions you should ask when it’s time to move on from your current billing company:


1. Are We Going To Be Able To Obtain Our Data?

You'll most likely have control of your patient demographics, since you’re managing the clinical side and the intake process. But what about the actual claim data and, just as important, the payment data? Many folks we talk to are either transitioning from billing company A to billing company B, or are working to take billing in-house. With the latter example, a lot of people are interested in obtaining their legacy claim data. The ability to capture claim and payment data from your time with your current billing company, either to port over to a new billing organization or to take billing in-house, allows you to track those trends Kaity mentioned in last week’s blog. Having that legacy data from your current billing company lets you hit the ground running when making a transition.

2. How Much Will Obtaining Our Data Cost? 

Many billing companies let you take control of your data, but will probably charge a fee. That’s fair enough, as it will probably take some work to organize and distribute the data to you in a neat package. But it’s good to know what that fee is upfront before deciding to move on. Just as important as the price tag is the timeline. How long will it take for them to provide that data for you? Say you’re planning to take billing in-house on May 1st. If your current billing company needs 60 days to provide the complete data set to you, you might want to have that conversation within the next few weeks, or at least before the end of February, allowing them to provide that information in a timely manner so you can access it when you decide to move in-house.

3. Will You Provide Coding?

Coding refers to the details your billing company puts on each of your claim forms, including revenue codes, CPT codes, bill types, modifiers, and place of service. If your billing company is particularly professional and friendly, they’ll provide you with a chargemaster or rack rate sheet – a one or two page document with coding information for the various levels of care you offer. If they can’t provide this information, you could request several sample claims for every service level you offer. For example, if you’re a detox facility and offer the spectrum of detox through outpatient treatment, you could ask for a few examples of each of the following:

- Detox claims

- RTC claims

- PHP claims

- IOP claims

- Any individual or group outpatient services you render

- Any additional professional services.

Doing so will help minimize the gap between your current billing paradigm and whatever you’ll be doing next. Say you’re fed up with your billing company, and you’ve decided to take billing in-house starting March 1st. If you fire your billing company before knowing they’ll provide you with your current coding, it may take a while to determine the appropriate codes for each level of care. Before you know it, it may be late March before you can obtain the full coding set and get those claims out the door. You can expect a gap in revenue that’s almost the exact same length as your gap in claim submission. An extreme example would be if you have a larger gap that results in timely filing issues. Payers have a range from 60 days to 6 months for timely filing. If you’re taking more time than you'd like transitioning, you may start running up against those timely filing deadlines much sooner than you realize.

ADDENDUM: Your Billing Company May Break Up With You First

It’s good to keep in mind that you might not be the one terminating the relationship.  Here's an example: you're a mental health facility specializing in eating disorders. Your current billing company offers substance abuse and mental health billing services, but over time they realize their strength is in chemical dependency/substance abuse. This realization results in them letting go of clients that are working primarily in mental health...like yourself. Having the above information squared away ahead of time will be absolutely integral to your continued success if this scenario happens to you. 

As with any relationship, it's all about open and honest communication. The better the communication between provider and billing company, the more successful both parties will be. The best time to ask these questions is when you're first starting your relationship. The second best? Today!


Check out "6 Questions You Should Be Asking Your Billing Company," a webinar created by Chris ReillyKenneth Throop, and Kaity McCraw from our Implementations team to learn more about how you and your billing company can work together to achieve success.




Further Reading:

-  3 Questions To Determine If A Billing Company's The Right Fit For You

3 Ways Electronic VOB & Eligibility Saves Money & Time By Finding The Right Fit

- Aspen Ridge & Avea: Sharing A Vision

- Why AveaOffice?


Greg Goode

Written by Greg Goode