Medical Billing Companies & Consultants in Guam (GU)

How to choose a medical billing company in Guam

A clinic on Guam bills a payer mix that few mainland billing teams have seen. Medicare and commercial plans sit alongside Guam Medicaid and the Medically Indigent Program (MIP), and both of those run through a territorial agency rather than a mainland state system. Your billing partner also works on Chamorro Standard Time, a day ahead of most of its payers' offices. A biller who handles the local programs and still gets answers from stateside payers beats the lowest percentage on a quote.

Where to find medical billing companies on Guam

Guam has no big cities in the mainland sense. About 154,000 people lived on the island at the 2020 census, spread across 19 villages. The most populous are Dededo, Yigo and Tamuning (which takes in Tumon and Harmon), followed by Mangilao and Barrigada.

For a buyer, that means a short list. You'll find a few island-based billing firms, some independent billers, and a much larger pool of off-island companies selling remote service. Because the island is small, any local firm can reach your office without much trouble. Specialty depth is the harder thing to find. If you run a dialysis center, a behavioral health practice or a surgical group, ask early whether the provider already bills your specialty for another Guam client.

Guam rules that shape a medical billing contract

Business license. Any company doing business on Guam needs a business license, and corporations, LLCs and partnerships must register with the Department of Revenue and Taxation (DRT) before a license is issued. Ask a local provider for its current license.

Business Privilege Tax. Guam has no sales tax. It taxes a business's gross receipts through the Business Privilege Tax (BPT), which the billing company owes on what it earns from you. Some firms pass this cost through as a separate line, others build it into the rate. Check which one your quote does so you can compare offers fairly. The rate has changed several times in recent years and is still debated at budget time, so confirm the current figure with DRT rather than relying on a number in a proposal.

Guam Medicaid and MIP. The Bureau of Health Care Financing Administration within the Department of Public Health and Social Services (DPHSS) handles provider enrollment, prior authorization, claims review and payment for both programs. Ask any candidate:

• How many Medicaid and MIP claims they submit each month, and for which practices
• Who handles your provider enrollment and revalidation with DPHSS, and whether that costs extra
• How they track prior authorizations and follow up on aging claims with the bureau
• Whether they bill the GovGuam employee plans and other island insurers you see most often

Patient data. HIPAA applies on Guam the same as in any state, so you'll need a signed business associate agreement before the firm sees a single chart. Guam also has its own breach notification law. It requires notice to residents when their unencrypted personal information is accessed and acquired in a way that causes, or is likely to cause, identity theft or fraud. Ask whether claim files and patient statements are encrypted in storage and in transit, who has to notify whom after an incident, and who pays for it. Put the answers in the contract.

Collections. If the firm will also chase patient balances, ask whether it does that work itself or hands accounts to a collection agency, and whether that agency is licensed to collect on Guam.

Choosing between an island biller and an off-island company

A local firm knows the payers by name. Its staff can drive to your office to fix a charge-entry problem, and they're awake during your workday.

Off-island companies often bring more staff, better reporting software and deeper coding benches. The trade-off is time. A mainland team's morning is your late night, and a team that has never filed an MIP claim will learn on your receivables. Some practices split the work, keeping Guam Medicaid, MIP and patient follow-up local and sending Medicare and large commercial payers to a bigger outfit.

What to ask before signing with a Guam billing service

Ask for two or three references from practices on the island, ideally ones your size and in your specialty. Ask them how long denials sit before someone works them.

Then read the contract closely:

• Fee basis. A percentage of collections is common. Find out whether it applies to all receipts or only to what the firm collected, and how old balances from a prior biller are priced.
• Term and exit. Look for a short notice period and a clear duty to hand back your data, open claims and payer correspondence when you leave.
• Who does the work. Ask whether coding or follow-up is subcontracted offshore, and make sure your business associate agreement covers those people too.
• Reporting. Insist on monthly reports showing denials by payer, days in receivables and write-offs, not just total collections.

Get at least two quotes, including one from an island firm, even if you expect to go remote. The city pages on Purchasing Reviews list the billing companies we know of on Guam by village, so start there and widen the search off-island if the specialty fit is not there.