Searching for a billing partner for your behavioral health practice can feel like a catch-22. You need their services precisely because you aren’t an expert biller, but how can you vet the quality of their services if you don’t specialize in it?
Luckily, a few guiding principles can help you separate the good companies from the duds. Even among the good companies, some may fit your needs better than others. When it comes to behavioral health practice billing, you want to ask 7 important questions and keep a lookout for a handful of red flags.
Before you do any of that, though, you need to get clear on your practice’s goals and how billing fits into them.
Define what success looks like for you
To find the right company for your practice billing, envision your larger goals. Why are you hiring an outside biller, and how would the ideal billing partner support your practice?
Some practices are aiming for large revenue growth and expansion. They might place more focus on poring over billing reports with an eye for growth opportunities, and staying ahead of behavioral health billing trends.
Other practitioners may want to maintain a comfortable income so they can keep doing what they love. They still need a biller who can maximize their revenue, but their biggest goal is just to offload the administrative work and free up extra time. For these practices, a third party that manages billing behind the scenes and delivers digestible financial overviews may be the perfect fit.
A satisfying relationship also depends on how much of the revenue cycle your practice needs billers to handle. For example, are you strapped for time and in need of a service to handle the entire revenue cycle? Or do you prefer to keep some part of the cycle in-house, such as handling patient billing for a more personal touch with your clients? Details like this can influence the success of a working relationship with a partner company.
7 Questions to ask when evaluating behavioral health practice billing services
Shop around before you commit to any service. Ask good questions and compare the answers you get from different providers. Here are 7 basic questions to help you discern a company’s competence in practice billing.
- Are you/your staff experienced with behavioral health practice billing in particular? The methods of optimizing claims don’t translate neatly from physical to mental health care. Mental health treatment is highly personalized to the individual client, whereas many physicians and specialists perform very similar services for all clients. The field of mental health has its own CPT codes and allows clinicians to bill by time spent with patients. The more behavioral health expertise your billers have, the better they’ll perform for your practice.
- How much of the revenue cycle do you handle? Some services cover the entire cycle, from claims creation to billing patients. Others only work with insurance companies, but not with patients. You’ll also want to learn how much work they do to negotiate with payers for denied claims.
- Who on your team will answer questions and provide support, and how can I get in touch with them? They should provide clear channels of communication and respond promptly to your inquiries.
- What’s your employee retention rate, and what background/experience do you look for when hiring? If the company has high turnover, there’s a good chance you’ll be shuffled from agent to agent and may not have a consistent representative working with your company. An effective billing company should have educated, experienced billers. If they hire newbies with no billing background in order to manage turnover or cut costs, your bottom line will suffer.
- What is your average AR days measurement? Industry standards suggest that a healthy company will have an average of 30 days in AR.
- What is your workflow? Ask how often they review claims and post payments. How frequently do they run reports on aging claims? What is their process for working outstanding or rejected claims? Ask open-ended questions so they’ll have to describe their work to you.
- Can I speak to other clients who have worked with you? This isn’t a foolproof way to gauge their service quality, since they will almost certainly connect you only with clients who give positive reviews. Still, it gives you some insight on what it’s actually like to collaborate with this company day-to-day.
Skillsets to look for in the ideal billing partner for your behavioral health practice
As you evaluate potential billing partners, look for companies whose employees demonstrate skill in the following areas:
- Checking patient coverage/eligibility
- Managing the claims submission process
- Precise CPT code billing that optimizes revenue
- Skilled negotiating to overturn claims denials
- Managing audits
- Managing accounts receivable and getting payments delivered on time
- Rapport-building with patients (if they will handle patient billing)
How much will I pay for outside billing services?
Most billing services will charge a percentage of your revenue, anywhere from 4-6 percent.
Make sure the service you choose charges a percentage of the amount received from payers, rather than a percentage of the amount billed. A fee based on money actually received increases their motivation to get you your full reimbursement.
Cost is a heavy-hitting factor in deciding whether to hire an outside service. Consider that the right billing partner for your behavioral health practice will likely increase your practice’s income. Many practices find that even after the biller’s 4-6 percent cut, they still make more money than before.
Signs of successful billers vs. red flags
How can you tell a good company from a shady one? Look for some of the common characteristics that make billers successful, and the red flags that should wave you off.
- First, they should have clear processes and workflows for submitting and following up on claims, and should be able to explain that process to you. This includes a regular cadence of reviewing outstanding claims and a protocol for responding promptly to denials and rejections. Aging claims should be reviewed every 30 days.
Red flag: They can’t provide you with a clear description of their process for claims review.
- Industry standards suggest that companies want to aim for around 30 AR days. If they get above 50, it’s a sign that something is wrong. Select a billing partner with a healthy AR days measurement.
Red flag: The company has a high AR days measurement or doesn’t disclose this information to you.
- Billing companies should hire educated, experienced billers who will get best results for their clients.
Red flag: The company hires inexperienced billers and experiences rapid turnover.
- To protect patient privacy, you need a billing partner that shields patients’ protected health information (PHI) with HIPAA-compliant software. Such software includes strong encryption, user permissions, and audit trails. A reputable company will sign a business associate agreement (BAA) assuming responsibility for compliance. This protects you from liability should the billing company have a data breach.
Red flag: The company won’t sign a BAA and/or can’t clearly explain the HIPAA-compliant features of their software.
Careful vetting of potential practice billing partners can make the difference between a beautiful partnership or a disastrous experience. Remember, you are hiring them to perform a critical service for your business, so they should be willing to clearly explain what they do and why they’re good at it.
With the right billing partnership in place, your practice will be better positioned for financial security and meeting long-term goals.
Valant is designed to streamline billing for behavioral health. Come see what we can do to help your practice increase efficiency and profitability.