Don’t Let Your Billing System Conversion Break Your Revenue Cycle (Part 2)

Editor’s Note: This article is the second in a two-part series by Roberta Schultz. The first installment can be found here on insidePatientFinance.com.

When converting to a new billing system, experienced healthcare providers know they will need additional resources during the transition or face increased A/R days out, claim denials, and filing adjustments.

Knowing you need an outsource partner and finding that partner are two completely separate activities. There are a lot of potential partners in the marketplace who will tell you that they can assist you with your system conversion, but how do you find that partner who will supply these services at the lowest possible cost to you and your organization?

Before you begin your implementation, before you even begin to write that RFP for an outsourcing partners, you must perform your due diligence to verify potential partners actually will help you through this transition rather than hinder you. What follows is a checklist of qualities you should consider building into your RFP:

Systems experience. First and foremost, you want a partner who has extensive experience with either your legacy system or with your new system or with both. Generally in our experience it is better to bring a partner to manage the accounts on your legacy system while your staff trains on the new one, but we have also had clients who have had us work on both old and new, which is a great way to share best practices.

Compliance. Your partner should have extensive knowledge and business practices that conform to all regulations and information security standards that you maintain in your own operation. Do they practice strict adherence to all state and federal guidelines, HIPAA compliance, and network security standards? Do they conduct staff background checks?

Productivity. You should expect any potential partner to share with you their respective productivity standards and how they will audit/report against those standards. It is important to establish how many accounts you expect them to work and over what period. Keep in mind that there will be a learning curve by your partner, so be suspicious of any claims to the contrary.

Performance standards. Does the staff of your prospective outsourcing partner possess the education and certifications you require of your own staff? Do they have extensive experience processing claims for Medicare, Medicaid, and private payers? You must review your potential partner’s audit procedures to make certain they cover those areas you need to be able to properly evaluate their performance.

Scalability. Does the partner have the resources available to ramp up and ramp down as needed through the conversion? Projects are all about change, and your outsource partner needs to be able to change with you. For example, if during the project you find your Medicare denials begin to escalate, does your potential partner have the resources available to add Medicare accounts.

The most important factor when selecting an outsourcing partner is their respective reputation. The response to your RFP only tells half the story; make certain you ask the potential partner to provide you with references from customers who underwent similar conversions.

If you perform thorough due diligence when selecting a partner for your conversion project, you will minimize risk to your enterprise, maintain your revenue stream, and keep costs under control.

About Roberta Schultz

Roberta Schultz is a director at ProSource Billing, Inc., a part of the Array Services Group family of companies. Roberta has over 23 years of healthcare Revenue Cycle and A/R management experience which includes managing various revenue cycle projects for multiple healthcare facilities including physician, hospital, and healthcare organizations.