Questions to ask a billing service before you sign.

Price

A quoted rate is only half a price. The other half is what the rate applies to and what sits outside it.

• What exactly is the fee charged on? A percentage of insurance payments only, or of patient payments too? Of claims you filed before they started? A good answer names the base in the contract.
• Is there a monthly minimum, a setup fee or a fee per paper claim? Each one changes the effective rate for a small practice more than for a large one.
• What is priced separately? Patient statements, credentialing and payer enrollment, cleanup of old claims, clearinghouse fees and reports are common extras. A good answer is a written list.
• How does the bill change as you grow? Ask for the fee at your current volume and at double it.

The guide to what a billing service costs shows how to turn any quote into a cost per visit you can compare.

Scope

“We handle your billing” can mean anything from pressing send to working every claim until it is paid. Ask step by step:

• Do you check coverage before the visit, or only after a denial?
• Do you review each claim against the signed note before it goes out? For chiropractic: the regions billed against the CMT code, the segmental dysfunction diagnoses and the active-treatment modifier where the payer requires it.
• Do you read every remittance and check each payment against our contract rates? A service that posts payments without comparing them to your fee schedule cannot find an underpayment.
• Do you work every denial, or only those above a dollar amount? Many chiropractic claims are small. A threshold can leave most of them unworked.
• Do you post payments and adjustments back into our EHR? If not, your front desk works from a ledger that is wrong.
• What do you not do? A clear answer here is worth more than a long list of what they do.

People

• Who works our account, and who covers when they are out? Ask for a name and a backup.
• What chiropractic experience does the team have? CMT coding, visit limits, plans that route chiropractic benefits through a separate vendor and payers that require a visit plan on file are specific to your specialty.
• Who decides a clinical question? The only good answer is your provider. A billing team asks; it never changes a signed note or picks a code the note does not support.
• How fast do you answer our questions? Ask for a number of business days, in writing.

Your money

• Where do payer payments land? In the practice’s own bank account, under electronic payment enrollment in the practice’s name. Be wary of any setup where payer payments pass through the biller’s account first.
• If you charge a percentage, how do you keep coding decisions with our provider? Percentage fees are common and not illegal in themselves, but the HHS Office of Inspector General has warned that they may increase the risk of upcoding. A good answer: the service never picks a code the signed note does not support, and your provider answers every coding question. For Medicare, OIG guidance adds that a billing service paid a percentage cannot receive Medicare payments into a bank account it solely controls.
• Who matches deposits to remittances? Someone has to, or a recoupment on an old claim hides inside a short deposit. The guide to matching deposits shows what that work involves.

What you see each month

• Will you report the five numbers every month? Net collection rate, days in accounts receivable, the share of receivables older than 90 days, the denial rate and the items nobody has worked. Here is what each one means. A service that cannot produce them cannot manage them.
• Can we see any claim’s history ourselves? Every status, every remittance, every denial and what was done about it.
• Will you show us underpayments separately from denials? They need different work and they hide in different places.

Your records and accounts

• Will you sign a business associate agreement before you see any patient record? HIPAA requires one. HIPAA also requires the agreement to say that when it ends, the business associate returns or destroys your patients’ information where that is feasible. Plan to take your export before that happens.
• In whose name are the clearinghouse account, the payer portal logins and the enrollment profiles? They should be the practice’s, with the biller added as a user. Accounts in the biller’s name make leaving slow.
• In what format can we export claims, remittances and denial history? Ask for a sample export now, not at the end.

How you leave

• What is the notice period?
• Who works the claims already in flight when we leave, and what do you charge on payments that arrive after? Agree on a run-out period in writing.
• How soon after notice do we get our records and accounts back?

The guide to switching billers covers the rest of a clean exit.

How Claims Native answers these

Price. $500 a month for a practice billing up to $10,000 a month in insurance charges; larger practices get a quote from their volume. One launch fee, quoted with your scope, covers enrollment, connecting your EHR, capturing your contract rates and the shadow period. Claim corrections, payer follow-up and appeals, payment investigation, insurance reconciliation, posting into your EHR and fixing our own errors are included. Bookkeeping, monthly close, cleanup of older balances and patient collections are priced separately.

Your money and records. Your money keeps going to your bank; we never hold it. You sign the agreement and the business associate agreement before any patient record reaches us. After the launch period it is month to month, and your records leave with you.

People and judgment. We check each payment against your contract. When the note does not support a claim, the question goes to your provider, once, and your provider decides what the note says. A person reviews every reconsideration, appeal and payer dispute before it goes out.

Sources

• 45 CFR 164.504(e): business associate contracts. Return or destruction of protected health information at termination.
• HHS, Sample business associate agreement provisions.
• HHS Office of Inspector General, Compliance Program Guidance for Third-Party Medical Billing Companies (1998).
• HHS Office of Inspector General, Compliance Program for Individual and Small Group Physician Practices (2000). Percentage arrangements and Medicare payments to billing services.