Third-Party Billing Companies [Healthcare Compliance Tips]

Query your third-party billing company regularly.

A common issue we see practices face with third-party billing companies is the “set it and forget it” mentality.

When it comes to your practice, it is important that you are involved in all aspects because you may still be considered responsible for any violations on behalf of your third-party billing company.

Therefore, the first step is increasing your communication with third-party billing companies to ensure they are following regulations.

Are you unsure of what to discuss?  If so, here are a few compliance-related questions you can ask, such as:

• Do you have a compliance program and do you monitor it regularly (i.e., HIPAA compliant, employee training)?

• Are you following the ‘OIG Compliance Program Guidance for Third-Party Medical Billing Companies?’

• Can you explain how you follow state and private insurance regulations?

• Where are your employees located, and can you provide us proof of employee experience (i.e., specialty experience)?

• What type of reporting systems do you use (i.e., coding/billing software)?

• Do you understand my documentation and is it accurate?

• Can you send me performance reports weekly?

After you ask these questions, complete an internal evaluation by doing the following:

• Evaluate whether the company is truly a good fit for you based on the initial conversation. If so, follow-up and create a new contract that includes old and new requests.

• For your team, create policies and procedures surrounding third-party billing communication practices (i.e., documenting phone calls, meeting schedule, review of reports for accuracy).

• Consider purchasing ‘Errors and Omissions’ insurance, which will protect your practice from their mistakes.

• Hire a compliance firm to audit your third-party billing company to ensure coding and accounts receivables are accurate.

Remember, when you ask the right questions, you set the tone for compliance, protect the patient, and your reputation.

If they want your business, they will do all they can to follow government regulations and your requests.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.