1. Paying Billers Based on Claims Submitted
Don’t fall for billing services that charge a percentage of claims submitted. Why? It disincentivizes them to do the hard work of collections. It also pays them an inflated amount of money, as submissions are always higher than collections (practices know they bill a higher amount so they don’t accidentally leave money on the table with an insurer). Instead, choose a biller who charges a percentage of collected revenue. It aligns their success with yours.
2. Ignoring Monthly Reports
Always request a sample report before hiring a biller. A good monthly report should show all claims submitted, paid, and outstanding amounts in a clear, digestible format. If the report is confusing or unavailable, it’s a red flag. Transparency is non-negotiable.
For good measure, ask them what a good collections rate is for your specialty. If they’re unwilling or unable to give you a number, it suggests they’re less likely to chase claim denials and drive toward the highest rate possible.
3. Neglecting Credentialing Details
Credentialing typos and missed updates can lead to denied claims. This happens more often that you think – a stray incorrect NPI number, forgetting to a new provider in a timely manner, an incorrect practice NPI (this is especially true for NPs who, for some insurers, are incorrectly listed as specialists even though they provide primary care). Ensure your billing team stays on top of practice and provider enrollments and NPI details. If they drop the ball here, it could mean BIG delays or denials in payments.
4. Assuming All Billers Understand Your Specialty or EHR
Not all billers are created equal. Primary care billing has nuances, especially in an NP-owned practice. Same for EHRs. Work with someone experienced in your field and system—they’ll know how to code properly and maximize collections. Ask them how many clients like you and get at least a reference or two.
5. Failing to Monitor Denials
Every denied claim is money left on the table. A good biller should not only track denials but also analyze patterns to prevent future ones. Make sure denial management is part of the package.
Take Charge of Your Billing
The right billing practices save you money and headaches. Do your due diligence, stay informed, and partner with a biller who prioritizes your practice’s success. Your revenue cycle will thank you!
