Medical billing can be a huge task, considering the constant changes in rules and the complications in submitting a claim. Also, after the huge hit due to the COVID-19 pandemic, the healthcare industry had to go through several updates and changes. Outsourcing is an excellent option to reduce staff costs, avoid claim denials, and ensure smooth processing. It allows healthcare professionals to focus on taking care of patients full-time.
Just like outsourcing is important, it is extremely crucial to choose a suitable medical billing company to hand over the process. Below are the 7 most important things you need to consider while choosing your medical billing partner.
Expertise & Experience
With so many companies in the market, it’s difficult to choose one. Check their speciality and account size. For example, some companies may be equipped to handle smaller practices with lower budgets, few insurance carriers, and few physicians; and vice versa. You may then decide as per your need.
Also, find a company that specifically has experience in your speciality so that there are fewer chances of rejected claims due to incorrect billing. With the expertise of the company, also enquire about who your contact will be and his/her expertise too.
All healthcare companies need to abide by the set rules and regulations. You may ask the company to provide a list of compliance procedures they follow to ensure that no rules are broken. Check if the staff is proficient in ICD-10, HCPCS, CPT codes and if the company is ISO-certified and HIPPA (Health Insurance Portability and Accountability Act) compliant.
Ask about their rate of rejected claims and how they handle their rejected claims. They should have a process for resubmission to ensure there is no loss of revenue.
Analytics & Reporting
You need to ask questions about how they deliver and how the work is divided between their staff. Some may allocate one biller who can provide undivided attention, but some may allocate different billers where you can get more done in less time.
It’s important to see how they will be reporting everything to you and their metrics to measure the success or denial rates. Understand if the company benchmarks its performance with MGMA or something similar.
Before signing the contract, it’s also important to know their style of communication; like how soon they would respond to your calls or requests, and what can be done if you have an urgent requirement.
The company could give you online access or should provide weekly or monthly reports on all the claims. Take a note of how frequently they conduct audits and how they maintain a monthly performance review process.
Like how we check before purchasing any product or service, it’s crucial to check what their previous clients have said about them. If you’ve been given references for the company’s previous partnerships, you may check them. Judge them by parameters like proactiveness, knowledge, service quality, and the impact on their revenue. The company can be a good fit only if it has delivered what it promised earlier.
Software and Tools
Medical billing companies need to be updated with the latest software and systems, so you need to know all this beforehand. They should be using software that is compatible with the one you use so that the flow of patient accounts and financial data is effortless. If not, check if they’re offering training to get you accustomed to their software. Ask questions about how they find solutions for technical issues and their suggestions on how to improve or automate workflows.
Data Transmission & Security
Look for a company that is committed to providing the best security possible for your Protected Health Information (PHI). They should have a secure and strong connection with no access to vital personal information. Similarly, you need to understand how accessible your claims and the information are to you whenever you might have questions. The company can never restrict your data from you and should readily provide them whenever you need them.
It all naturally boils down to the cost. Get a clear understanding of which services are included and which are excluded in the pricing. Discuss the carve-outs related to your services transparently with the company. Some companies may charge extra for certain billing and coding services which can later get expensive. Hence, it’s important to know them all.
Some companies may charge by a percentage on your revenue, some may charge a flat fee, or some may charge a little of both. Comparison among different companies can help you decide what works best for you.
Make an informed decision after considering all the above points. 24/7 Medical Billing Services can be an appropriate choice for all your requirements. We are 100% HIPPA-compliant and use the latest high-tech software. All our 500+ highly experienced staff offer round-the-clock availability (in the whole week), claim submissions within 24 – 48 hours, and a standard of 99% clean claims. Even if we serve over 42 specialties, we guarantee customized and innovative solutions for each of our partners.
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