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How, as a provider, do you make sure that you control your data? Some providers choose a billing company, and some choose to bill in-house. Sometimes, billing in-house is selected to maintain control. It could be that this is to maintain control of billing processes, although one of the reasons we’ve seen frequently is to control data to mitigate risk.
Is your data out of control?
This is a significant concern. Many organizations fear someone else having access to their data and controlling their data where they do not control it. What if the billing company goes bankrupt? What if they fall into the ocean, there’s a tornado or earthquake, whatever it might be? What if the company’s unethical and decides to take advantage of you or charge you some exorbitant fees?
I will tell you we did see a situation like that less than a decade ago, where we saw a software vendor who essentially decided to violate their contract. They charged some exorbitant fees. When the provider didn’t pay, they effectively shut everything off. They were incapable of billing, and they essentially extorted money from them. So we’re not trying to scare you. It’s just that those things can happen. They’re uncommon, but they can happen. This often forces provider organizations to choose to bill in-house.
Are you managing billing effectively?
Maybe, billing in-house is the best for the organization. Maybe, outside billing is the best. We’re not trying to push one way or the other. But if you’re choosing a billing company, often then what organizations will do is they will force that billing company to use the in-house electronic medical record or clinical system, laboratory information system, whatever it might be, to do the billing because they want to control the data and make sure that they have access to the data and that the billing company doesn’t handle it.
That is an option, and it may be a good option for an organization. But the question is, “Is that the only way?” We want to suggest and lay out the potential for a third option.
We believe that, given all the complexity of revenue cycle management, it needs to control what software applications it uses to generate the best financial results for a billing company to be successful. Again, reiterating, we have no bias towards a billing company or in-house billing. But if you’re looking to have a billing company to do the billing and want to keep your data, there is a third path.
How to control your data to be safe in case something happens to them? You can pursue a path that has the billing company do daily exports of data. This could be a full-on live interface that transmits data back to your primary clinical system, electronic medical records, radiology information system, whatever it might be. That is a great approach.
You can push those records back directly into another system, so you have all of that data. However, this is time-consuming and relatively expensive, so you’ve got to have some significant scale to make that work. It’s pretty unlikely you can do that by the time you want to go live. So it might take another 6 to 9 months after you go live to access that data or have it working correctly.
Consider data warehousing
Another option is to interface to a reporting or data warehouse solution. We like this option a lot. Not only do you have the ability to keep your data and to have it be safe, but you can use the data for analytics. Again, this is time-consuming, expensive, but in our opinion, this is worth it. This may be the best option you have. Suppose you don’t have the economies of scale to afford to do something like that, and you’re looking for a low-budget version of how to make sure that you have access to your data to control it and make sure that you are safe. In that case, we suggest that you get daily reports exported from the billing company system.
Many systems can export 835 and 837 files. The clearinghouse may have access to those files so that you could get them directly from the clearinghouse. As long as you have access to that, you can set it up to get those days and get all the 837 and 835s. They could be HL7 files. That means that the billing system doesn’t make a full-on live interface and work through all of those headaches, but it does generate HL7 files and kick those out daily.
You could easily use those at some point in the future if you need it to get up and running quickly and run those through an interface engine and drop them into either another billing company system or your system to work your existing accounts receivable or to get up and to run to submit new claims and get them out the door.
Add contractual requirements
If those aren’t options, or they’re too complex, or they don’t have the capability, or whatever it might be, you could have just flat files exported like CSVs or comma-separated value files. But you want to make sure that you specify precisely what you need.
Given the fact that the fields that you need might not all be in one report, much less even two reports, you might need three, five, or even seven different reports to be generated regularly so that you can get all of the data that you need to bill instantly if, for some reason, you needed to take it over at some point in the future or have somebody else to take it over.
You can make this a contractual requirement. You can put it into the contract that says that they’re dropping information into some third location daily. It can be a shared file folder, which is an excellent place like Box or Dropbox. Google Drive exists as well. There are commercial versions that are easy to test that many companies use. You can set it up so that daily, they kick those out, drop them in that folder, and you can make virtually no money. You have an IT person to set it up so that there’s an automatic sweep of that folder daily.
Those files are transferred via secure FTP, HIPAA compliant, onto your servers or your local box. Again, it doesn’t even have to be a server. You can have it be on a desktop that’s running full time, that goes at midnight every day. You’ve got all of that information that’s ready to use at any point if somebody needs to access it.
The trick to it, the key though, is to make sure that the data you’re getting is sufficient to get you up and running if you needed to do that at some point in the future. You don’t want to have a charge file come out, or maybe a charge in a payment file come out and then find out, “Ah, this doesn’t tell me what I need. There’s no place for service code in these files,” or “There’s no submit date in these records,” or “There’s no date of service in this one,” or “There’s not a diagnosis in this particular report. It’s in a different report,” after the fact, once you have a problem that you don’t have all the information you need.
So somebody would need to go through and make sure you set up those requirements correctly. Someone between a data analyst and a good billing manager or somebody like that could go through and figure out all the fields you need to get that setup.
Control your data to stay safe. If you decide to partner with a billing company, let the billing company use their judgment on the right software to generate the best performance for you. It’s the best of all worlds.