Apparently, many people have been promised things that were never delivered when dealing with medical billing services. Sadly, I don't know of any companies that I really feel comfortable recommending. What I can offer is a few tips when looking for a billing service:

Experience: Personally, I put this at the top of my list. I don't want to spend time and money dealing with someone trying to climb the learning curve.

Investment: What are they doing specifically to stay ahead of the ever changing world of medical billing? If they are paying for people to take classes, ask to see some certificates.

Size: I don't like to go with massive companies, but I refrain from hiring one man shops as well. Basically, I want the company to be small enough that if I call, I am never on hold for more than one minute. However, I also avoid being the only client a company has.

References: I take this part very seriously. It isn't just about verifying that the references exist, I like to ask the references specific questions. I would ask, for example, if the billing company had ever fallen behind. If the reference says no, I know right away they are not telling the full truth (everyone falls behind at some point).

Reports: Don't just ask what types of reports they can produce. Ask what they have experience in doing and then request to see two examples from a past month. If there is any delay in producing this, I'd begin to wonder how truthful they were being.

HIPAA: What metrics have they taken to meet with the necessary guidelines? Many people feel that outsourcing the work to other countries creates a liability. I don't agree that non US citizens are any more or less likely to violate HIPAA standards when standards are in place.

There are obviously many other details to consider, but these are a few that I always like to keep an eye out for. They may also apply to other types of services as well.

Our billing staff is small in our office, so when accounts go past due for more than 120 days, we send them to a collection agency. It is the ugly fact of modern medicine that some people cannot pay for proper care, so it is with a heavy heart that we do this.

The agency we use charges 30% of what's recovered, and they have a pretty good track record. They have recommended that we cut our collection time to 90 days, as the longer you wait, the harder it is to collect.

I recently read a survey that said after 90 days, a business has only a 69.6% probability of recovering its money. After six months, the odds drop to 52.1%. Those are daunting numbers, but I am less than sanguine about squeezing every patient dry. We make a healthy profit, and often the people who don't pay can't. Officially, I cannot condone such behavior, but privately, I am sympathetic.

Often, I will take delinquent accounts home with me and review the history. If a person is elderly and without insurance or a means of support, or if they have paid something but seem genuinely unable to complete the payment, I sometimes make a judgment call. After all, we're in the business of making people healthy, not bankrupt.