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Buying Guide for Medical Billing Services
Introduction to Medical Billing Services
In the hectic ever-changing world of modern medicine, one thing holds constant: the need for medical billing services. However, thanks to new options, it is now possible to outsource the medical billing services function for your practice, allowing you and your staff more time to focus on building a sustainable, profitable and effective practice.
Services provided by medical billing services providers:
- Patient scheduling.
- Practice management.
- Invoicing (patient, vendor).
- Billing and collections.
- Insurance appeals for denied/unpaid claims.
- Patient and insurance inquiries handling.
With this Buying Guide, you can learn what you need to know to make an informed choice among the variety of HIPAA-approved medical billing services available today. You can decide which features to opt in for, how the decision to outsource can save you money (around $4 per transaction) and what you can expect to pay for taking this task off your hands.
Medical Billing Services Benefits
It is estimated that a practice with 6,200 claims per year can save as much as $42,000 per year by outsourcing the medical billing services function. Your goal is to find a services provider that saves you more than what you need to spend on fees. This will occur when the provider can recoup what you are owed more quickly than you could on your own, reduce unpaid claims sent to collections, increase claim acceptance and improve compliance.
How to know if outsourcing is right for you:
- Are you a small solo practice with a high patient volume? If so, you probably don't have time to efficiently handle your medical billing. Outsourcing may be a good fit.
- Are you a small practice with a low patient volume? You may not find enough value in outsourcing to justify what it costs you.
- Are you a larger practice with a high patient volume? Here, your staffs are unlikely to be able to match the efficiency and effectiveness of a full-on medical billing services provider. Outsourcing may be a good fit for you.
Outsourcing Medical Billing Services
One question you likely have is "How does outsourcing my claims to a medical billing services provider actually work?"
While of course there may be small variances from company to company, in general you can expect a work flow similar to this:
- You send each day's patient data (patient data, insurance provider, diagnosis, procedure codes) to the billing service.
- The service double checks the information and then fills out and submits the claim forms.
- EOBs (explanation of benefits) and checks are sent to you as approvals come in.
- Denied claims are sent back to the billing company for processing (resubmission or return to you).
- Collections is ongoing for overdue accounts.
- The service issues reports to you regularly.
In addition to this standard list of services, you can opt in for certain specialty services as you may have the need and based on what the provider offers.
Typically you can submit patient information to the billing service on paper, by email, via specialized software, using your mobile device or over the web. In general, electronic submission formats are preferable since they cut down on entry errors and reduce processing time. As well, they tend to be safer and more secure.
Other critical services to look for:
Does the medical billing services provider "scrub" all claims to look for missing or inaccurate data before submitting each day's batch of claims?
How often are follow-ups done to resolve late payments and denied claims?
What options do you have for receiving your EOBs and payment checks? In general, use of a bank lockbox or electronic processing software tool is preferable.
Choosing a Medical Billing Services Seller
Since there are literally thousands of sellers who will be eager to do business with you, you can benefit from using this checklist as you shop for the seller who offers you the best overall package.
- Look for a seller who has expertise in your specific industry.
- Look for a seller who is established in the medical billing services field.
- Look for a seller that prioritizes HIPAA compliance.
- Look for a seller with strong familiarity with the new updated National Provider Identifier (NPI) system.
- Look for a seller with a great staff implementation and training program that includes ongoing support.
- Look for a seller with domestic customer service and training staff (this avoids language barriers and other issues that can impact customer service and satisfaction).
How to determine if the medical billing service provider has expertise in the medical industry specifically:
- The seller should demonstrate proficiency with advanced medical terminology and HCPCS, CPT4, and ICD9 coding.
- The seller should be both OIG and HIPAA compliant.
- The seller should be proficient with internet technology and software.
- The seller should be an expert in the field when it comes to claims processing, denials and appeals, collections, reimbursement, insurance billing and fraud detection.
- The seller should willingly provide customer references.
- The seller should be known to other sellers in the field!
Medical Billing Services Pricing
It is a typical industry practice for medical billing services to bill each client for a percentage of collections. Most often billing is done monthly, and the burden lies with the billing services provider to collect more so they earn more.
- Most billing services charge between 4 and 14 percent per client.
- Most clients pay between 5 and 6 percent of collections to the provider.
- Per-contract charges average $3.50 to $4.50 per claim.