Selecting the Right Medical Billing Services

Revenue collection is the backbone of every business but it is more so in the case of medical practices as they cannot stop attending patients all of a sudden and the depletion of money is slow and steady. This makes it difficult to detect and gain control over finances. It is thus extremely important to keep a tab and analyze the revenue cycle regularly.

An outsourced medical billing service helps providers reduce their administrative and backend billing process drastically. For selecting the right billing service a medical practitioner should know the following things about the billing vendor:

  1. Capability and Point of Contact

This is one of the primary things a provider should ask a billing vendor – their expertise and experience in handling billing for specific specialty. The provider should know whether the billing partner can handle the entire process given the size of his practice and average number of patient visits.

If you run a cardiology practice, you may want to ask the company if you will have a designation personnel to review the cardiology billing and ensure accurate reports are sent to you regularly. This person should ideally also be your 24/7 point of contact.

  1. Qualification and Experience of Staff

The most common reason for claim rejections and denials is billing errors. An experienced staff will know the terminologies, latest CPT (current procedural terminologies) and ICD (international classification of diseases) codes. The billing vendor should have CPC certified ICD-10 coders considering the approaching deadline for ICD-10 implementation, October 1, 2015.

Not only the errors cause delay in reimbursement but also takes up considerable time in following up with the insurance carriers. Ask the billing vendor for the average percentage of clean claims they maintain.

  1. Support for Training and Billing

With the constantly evolving healthcare reforms like Meaningful Use (MU), for improving care provision, the usage of electronic health records (EHR) has increased manifold. The billing company should have the infrastructure and experience to handle the transition, and the knowledge of using various practice management or billing software.

Apart from this, one should also inquire whether all the billers and coders are well acquainted with deciphering data from EHR and equally proficient with handling superbills in hardcopy. In case you wish to switch to EHR from traditional storage, the billing partner should be able to assist you or train your staff accordingly.

  1. Timeline for Reimbursement

A billing company should ideally be able to file your claims within 24 – 48 hours and maintain the lowest possible account receivable (AR) bucket as applicable for specific medical specialties. In case of any delay in reimbursements, one should pre-decide the amount to be deducted or reduced from the fees. It is good to have a process in which the teams can have simultaneous access to the progress status of the filed claims.

  1. AR Recovery Team

If there’s one team that you should pay a little extra for, it is the AR team for the religious follows ups they do. Off late pending ARs are a common thing considering the number of rejections and denials due to compliance issues. This team should be conversant with understanding the explanation of benefits (EOB) well.

Apart from the points mentioned above, the monetary factor should be transparent and include all kinds of charges involved in the billing services. It is also advisable to have a prior consensus on the expenses for upgrading technology.

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