Avea Solutions Blog

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!

"What's new?" Avoiding stagnation is critical for maintaining any relationship. Keeping your finger on the pulse of the latest industry shifts is the best way to make sure your claims go through correctly the first time; and to help make sure this happens, your billing company needs to be aware of changes that could affect your process. 

Below, I've assembled 4 questions you should be asking on a regular basis to ensure that your claims are processing correctly based on the most current information: 

 1. WHAT TRENDS ARE YOU NOTICING WITH MY CLAIMS?

This is something you can bring up on your weekly call to help determine if you have a billing company willing to go the extra mile. Trend tracking is essential, both for ensuring that your claims process quickly and to make sure your billing company is being as efficient as possible.

 A few follow up questions you can ask: How are they tracking claims specifically? Are they running any reports to help you track trends, or that they use to track trends internally they'd be willing to share with you? Also ask if they use control groups, tests, or other scientific methods to work claims. From my perspective, working claims is more of a science than an art, so it’s important to work them in groups with similar issues to determine if they really know what’s going on.

One example I ran across recently is medical records being denied for a certain facility, stating that the service rendered doesn’t match the level of care billed. If the billing company is working these claims as a one-off, they might not think to mention this to you. But if they do notice a trend, they can bring it up on your weekly calls with them and suggest something your rendering providers could be doing differently with documentation, or provide suggestions from specific payers regarding what they consider the level of care.

2. WHAT TRENDS ARE YOU NOTICING INDUSTRYWIDE?

Because billing companies have access to claims other than yours, they have a broader scope of what’s going on across the country with many different payers, even ones to which you don’t currently submit. Knowing that your billing company is willing to share their industry knowledge with you and leverage what they’ve learned from other clients to get you paid faster is huge.

I like to think of these trends in a few different groups. There are issues that are just based on insider knowledge from working in the industry, like procedure codes that are not allowed, such as drug screenings and G-codes, which change from year to year and quarter to quarter. Another example might be bill type switches, the requirements of which change all the time and are payer specific. If you can keep a pulse on that and make sure your billing company is doing the same, that’s really going to help develop trust and strengthen the relationship.

3. ARE WE HAVING ANY ISSUES WITH TRACTION?

Ask about issues that bubble up when your billing company notices a trend. One of these I’ve recently discovered is United Healthcare out of scope denials, which is when a claim denies specifically stating that the service rendered was outside the scope of the provider’s license. Claims reps don’t necessarily know what these denials mean on the payer’s end, so you really need to get someone knowledgeable on the payer’s end for the billing company to speak with. When I drilled down on this, the most frequent reason for these denials was missing documentation in the payer’s system that had not been requested by the provider relations department. This relates to what we referred to earlier about owning your relationship with the payers; having said that, you can also speak with your billing company to ensure everything is up to date.

4. WHAT ISSUES ARE STILL BEING RESEARCHED?

Related to transparency, this question is to determine if your billing company is prepared to own up to issues where even though they're unsure of the direct cause, they're still actively researching. One example is UHC medical records. This is a new issue within the last couple of months, where UHC is denying them as “incomplete.” It’s a challenging denial to fight, but it's also very important for you to be aware of if it's affecting you.

Basically, these are all good things to ask your billing company about on a weekly basis during your check-in calls, and really build up the level of trust you have with them.

Check out "6 Questions You Should Be Asking Your Billing Company," a webinar created by Chris Reilly, Kenneth 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?