How to Choose a Medical Billing & Management Service

How to Choose a Medical Billing Management Service

Of course, we all know that no matter what industry you’re in, choosing a vendor is definitely not an easy task. However, knowing what questions you need to ask will make this process a lot easier. Following, you will find three things that you should look for when you are choosing a medical billing and management service as well as questions that you should bring up to determine if they are a good match for you.

Never Choose a Vendor Based on Price

Full service medical billing companies with experienced medical billers and advanced revenue cycle technology can get a premium for their services because total collections are significantly higher. However, if you happen to be concerned with cost, you should never assume that you’re going to get a better deal from a discount provider. Chances are, with the discount providers, you’ll end up with less revenue in the long run.

For example, there are some of the large, well-known service providers that advertise they have a 2.9 percent collected revenue rate with 94 percent of their claims accepted on the first pass. However, that discounted rate does not include insurance follow-up. When you have no claim follow-up, then you have 6 percent of your insurance claims that are not paid, which means you are losing an average of $1,400 to $1,800 per month. Suddenly, this amazing low rate isn’t such a great deal after all.

You really want to choose a medical billing company that is highly productive and less likely to make unnecessary errors. In addition, you want to choose a company that will be committed to collecting all of the revenue you’ve earned.

Be sure to ask the following questions before hiring a billing company:

  • How many reps will be assigned to my account?
  • How much experience in the industry do they have?
  • How much experience in my specialty do they have?
  • How do you make sure that your billers keep up with current codes and regulations?
  • What is the average time in AR for my specialty?
  • How many charges are typically turned over to collections?
  • What policies will affect my current billing process?
  • How can you ensure that personal health information is protected?
  • What insurance coverage do you have? (security breach liability/coverage for errors/omission/etc?)

In addition, you need to make sure that the company you choose is in compliance with all federal/state laws that apply to your practice.

Don’t Underestimate Technology

Technology has come a long way. One thing you must keep in mind is that there’s a huge difference between the billers that are still working the traditional way with faxes and manual data entry and those who are using a cloud-based cycle management. Think about your personal banking. There are still some who prefer paper bills and write checks, while there are others who prefer to get bills online and pay with a click of their mouse to avoid paperwork and postal delays.

With the right management company, you can be connected with remote billing which means you’ll have fewer errors. Eligibility and coverage for your patients can be checked before you even see the patient. A medical coder can directly access patient data, clinical notes, and insurance information, which eliminates any complications for the visit. Any denials will be received almost immediately to be dealt with instead of sitting for a week or two in a “to-do” pile on someone’s desk. Plus, with cloud-based systems, the data is automatically in compliance with HIPAA data storage rules/regulations.

Be sure to ask the following questions:

  • Does your company use cloud-based software?
  • Will your software integrate with my EHR or do you offer integrated EHR?
  • Does your software remind you of deadlines/denials of claims that need to be handled?
  • How do you deal with the payers that only take paper claims?
  • What are your procedures for data backup/disaster recovery?

Expect Total Transparency

In the past, one of the most critical disadvantages to outsourcing billing was the fact that you lost the financial data you needed to manage your practice. Once you outsourced it, you had to depend on the reports that were supplied to you by the biller to determine how your practice was doing financially. You had to manage your practice forensically, since the reports were historical by the time you received them. This meant that they were useless in regard to proactive/real-time decision making.

On the other hand, medical billers today are using cloud-based systems so you have the complete opposite. You can access your claims 24 hours a day, 7 days a week and get any information you need such as days in AR, claim denials, etc.).

At this point, you should understand that the key to successfully outsourcing your billing process is a combo of experienced individuals with modern technology. You want a billing company that has expert employees and has an understanding of exactly how valuable advanced revenue cycle management is. Once you have found this, you should just ask the right questions.

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