Medical Billing Companies & Consultants in Michigan (MI)

How to choose a medical billing company in Michigan

Where Michigan medical billing companies are located

Michigan Medicaid claims go through CHAMPS, the state's own claims system. Any billing company that submits electronic files for a Michigan practice has to be enrolled there first. That one detail separates firms that already work with Michigan payers from firms that just say they do.

Most billing companies are in metro Detroit. Detroit is the state's largest city, and the nearby suburbs of Warren, Sterling Heights, Dearborn and Livonia add hospital systems, specialty groups and the billing firms that work for them. A practice in Wayne, Oakland or Macomb County can usually find firms that focus on its specialty, such as anesthesiology, behavioral health or physical therapy. Many will meet in person.

Grand Rapids is the second largest city, and the metro area around it had more than a million people in 2020. Ann Arbor, Lansing and Flint each have a smaller group of billing firms, often built around a university health system or a regional hospital. Outside those areas the choice shrinks quickly. In southwest Michigan, a practice in Constantine or another St. Joseph County town may find a nearby independent firm. Many practices there also hire a regional company from Kalamazoo or a fully remote company. In the Upper Peninsula, remote service is often the only practical choice.

Michigan rules to check before you sign with a billing company

Several state rules affect how a billing company handles your claims, your patients and your data. They are worth raising in the first meeting.

• Medicaid billing agent status. The Michigan Department of Health and Human Services (MDHHS) requires billing agents to enroll in CHAMPS. A practice can't link itself to a billing agent until MDHHS has approved that agent. Ask for proof of approval and find out how long setup and testing took for the company's last new client. MDHHS also bans using or storing this data on servers outside the United States. Get that in writing if the company uses offshore coding or follow-up staff.
• Collection agency licensing. The Department of Licensing and Regulatory Affairs (LARA) licenses collection agencies under the Occupational Code. That covers firms that collect debts on someone else's behalf. Licensed agencies must carry a surety bond of $5,000 to $50,000. If the billing company will chase past-due patient balances, or send them to a collection agency it partners with, ask whether that work needs a license and who holds it.
• Surprise billing limits. The Surprise Medical Billing Act, Public Act 234 of 2020, limits what out-of-network providers can bill patients in covered situations. The Department of Insurance and Financial Services (DIFS) reviews insurers' payment calculations when a provider asks and runs the arbitration process. If you are out of network with some plans, ask the billing company how it spots these claims, how it keeps them from going out as patient balance bills, and whether it has filed a DIFS review request before.
• Breach notice. Michigan's Identity Theft Protection Act requires notice to affected residents without unreasonable delay after a security breach. A third party that holds the data has to tell the data's owner. Your contract should require the billing company to notify you quickly. It should also say who pays for notifying patients.

Sales tax mostly comes up on the software side. Michigan charges its 6% sales tax on prewritten software but generally not on services or on software you only access online. If a quote bundles a downloaded practice management program with billing services, ask how each part is taxed. Rules and dollar amounts change, so check current figures with MDHHS, LARA, DIFS or the Department of Treasury before you rely on them.

Comparing local and national billing companies in Michigan

National companies offer scale and around-the-clock staffing. Local and regional firms usually know the Michigan payers better. Ask any company you're considering how it handles Blue Cross Blue Shield of Michigan, Priority Health and the Medicaid health plans. Ask about prior authorizations, denial patterns and the payer contacts it actually calls. A firm in Grand Rapids or metro Detroit that works these payers every day will often fix a denied claim faster than a national team working from a general playbook.

On-site help matters less than it used to, but it still counts during setup. Having someone in your office for a week while you switch systems, train front desk staff or clean up old accounts receivable can save a lot of phone calls. After that, most of the work happens remotely. What matters then is whether you have one named account manager and how quickly they reply.

Ask for references from Michigan practices that match your size and specialty, and call them. Ask them how long payments took to come in during the first 90 days and how often reports arrived late. Then ask whether they would sign again.

Questions and contract terms for a Michigan billing company

Fee structures differ more than most practices expect. A percentage of collections is common, but check what it's a percentage of. Some firms take their cut from every payment received, including copays your own staff collected at the front desk.

• Is the fee based on net collections, and are patient payments taken at the desk left out?
• Who works old accounts receivable from before the start date, and at what rate?
• Which billing and clearinghouse systems does the company use, and who owns the data if you leave?
• How much notice is needed to end the contract, and is there a fee for doing so?
• Will the company sign a HIPAA business associate agreement that includes the Michigan breach notice terms above?

Watch out for automatic renewals and long notice periods. Also check for a clause that charges you to export your own records. A fair contract gives you monthly reports that break out denials by payer and reason. It also lets you leave with your data in a format your next company can use. Read the termination section before the pricing page. It tells you more about how the company works.