Compliance, reputation should be your top concerns

Why This Topic Matters

Outsourcing billing can affect reimbursement, compliance exposure, and a practice’s reputation, so organizations need a clear way to assess a vendor’s controls and monitoring practices. The article helps readers understand the broad compliance and oversight topics that matter when working with a billing company.

Article Sections

1. Selecting and evaluating a billing company

   This section introduces broad criteria for assessing a billing company’s experience, compliance posture, and preparedness to handle claims work. It frames the vendor-selection concerns discussed throughout the article.

2. Compliance plans, audits, and oversight

   This section covers compliance planning, internal and external review practices, and the role of audit materials in vendor oversight. It also discusses the importance of policies and procedures documentation.

3. Coder credentials and monitoring claims activity

   This section addresses credential verification for coding staff and ongoing monitoring of billing activity and errors. It also includes communication and review practices used to keep track of claim performance.

4. Contracting and ongoing review

   This section discusses contractual expectations for compliance planning and continued monitoring after the vendor relationship begins. It also touches on periodic sampling of claims submitted on behalf of a practice.