Medical Billing – Importance of Due Diligence Process

Since early 2000, US medical billing companies have realized that outsourcing a part of their billing functions to offshore medical billing vendors can be beneficial. With the offshore vendors’ assistance, US medical billing companies can easily face billing complexities, sophisticated technology upgrades, and compliance issues while also bringing down the cost of Operations without compromise in quality of work.

However, such benefits can be enjoyed only if they partner with the right offshore vendors. In order to partner with the best offshore medical billing vendors, a US medical billing company must first carry out what is called the ‘Due Diligence Process’. Let us deliberate on this topic further:

Definition: Due Diligence process is a kind of research performed by US medical billing companies to check on the background status of offshore vendors with whom they plan to work with.

Steps involved in the Due Diligence Process:

  • The first main aspect that a US medical billing company should check for is the fiscal status of the offshore vendor, so reviewing the size of the vendor and the number of years in business gives a fair idea of the vendor’s financial health.
  • Checking for the offshore medical billing company’s sustainability through reference checks from current clients can give the outsourcing medical billing company a detailed view on its performance.
  • It is highly important to check for an offshore vendor’s total years of experience and the number of clients it handles. Because, higher the years of experience and client numbers, better the performance and scalability.
  • A US medical billing company must make sure that the offshore vendor it is planning to partner with has enough staff members to support the current needs and potential for expansion with growth of business.
  • It should also check if the coding specialists working for the offshore medical billing company are AAPC certified.
  • Once that detail has been checked, an US medical billing company should inspect if the offshore vendor is compliant with the HIPAA standards. It can also inquire about ISO certifications and get copies of the certificates, if the offshore medical billing company belongs to India.

In case, a US medical billing company fails to carry out the Due Diligence process, then the results might directly impact its revenue cycle management. As in the US, there are many small start-ups (‘mom and pop’ shops) that claim a high level of medical billing expertise in this domain but lack even the basic infrastructure or staff to handle the flow of work. Therefore, it is highly advisable that US medical billing companies perform Due Diligence analyses and hire reliable, high-performing offshore vendors like eCare India, which is both ISO 27001:2005 for Information Security and Management Systems and ISO 9001:2008 certified for its processes and is HIPAA compliant.