Chapter 11
What to Look For in a Billing Company
As we have seen, Genesis has automated everything with the exception of following up on claims that need a phone call. So the word billing in billing company really does not apply anymore. We are really a follow-up company. For clients who keep things in-house and use Genesis, they really do not have a billing department anymore. They have a follow-up department.
What You Do Not Want
Sometimes it is easier to think about what you do not want rather than what you do want. We’ve already covered what you do want and why. Here is what you do not want in a billing company:
- No automation, just lots of experience
- You do not want a company that does not have automation and just says they have lots of experience or are really great billers. Genesis has been in the business for 14 years and processes millions of claims for practices all over the country. We have many expert certified coders (hundreds, actually) with lots of experience on our team. You might be saying, So what?
- One biller does not know more than what insurance companies have built into their AI. What happens tomorrow when the insurance company changes tactics? Are billers looking at data across thousands of practices and millions of claims? Are they building new automation and AI to fight back against insurance companies’ tactics? Can one very experienced person follow up on millions of claims?
- No accountability
- I used to outsource to a company that would send me lots of reports every month. Guess what? I never had time to look at them. If you cannot see top-down reporting of their work in real time, forget it. How many claims need follow-up today? What is your AR > 120 days? Then drill down into reports from there if you want to or need to. That’s what Genesis offers. Billing companies love to talk about their reports and how they log into your system. No good. No control, no transparency, no accountability. You will wind up not trusting them.
- They don’t outsource follow-up
- I know what you’re thinking. I don’t want to speak to someone in India. Of course not. We would never ask a client to do that. With Genesis, you always speak to a resource in the United States. But we do want the insurance company to speak to someone in India (or another country). Why? Because they are doing the same thing. Remember how we said they have unlimited manpower? If we are going to beat them at their own game, we must do the same. Outsourcing your claims follow-up while still giving you transparency is one of our secret weapons. We have hundreds of follow-up resources in other countries driving insurance companies crazy every day. They are managed by resources here in the United States. They are only paid when you get paid.
- They use another software
- If they are using another software, then no thank you. I shouldn’t have to explain all the reasons that this is a deal breaker. Your practice management end must be tied to your billing and follow-up if you want real control, transparency, accountability, and a chance to beat insurance companies at their own game.
- Even if you are using another cloud-based system, it is not enough. That would mean the biller is using the same exact system. But what about Single Point Management? Yes, control and transparency.
- Low fees and what they mean
- A billing service should be charging only a percentage of what you collect from the insurance company—not on copays and deductibles. You want them to have all their incentive focused on getting the money you deserve from insurance companies. The average fee for this in chiropractic is between 6% and 10%. The number varies based on what your average collection per claim is. Anything lower is a big red flag. It means they are probably not going to follow up on every single claim and that they will just take the easy money. Since most of them have junk technology, you’ll never really know.
- The low fee also tells you they are not investing in technology and are most likely using the system you already have and logging in remotely or using some other system. See #4 above. That’s a deal breaker.
- Some billing services advertise a very low percentage, but then you find out it is a percentage of what you charge. Some of our clients actually want this for some reason, and we do it. However, you’d better make sure you have a way to see everything they have done on any claim and have a way to know they are following up on every single claim that needs it.
- Some charge a lower percentage but take a percentage of everything you collect, including cash, copays, and deductibles. Watch out for that one.
- Another pitfall of low fees is that no system (except Genesis) can track underpayments. So while they give you a low percentage, you never really see the income from your underpayments. They just do not have the technology or enough workers to go after that money for you. It could cost you tens of thousands of dollars per year. If you do not keep insurance companies accountable, they will continue to take advantage, and it will only get worse.
