Medical Billing Companies: How To Pin Down The One That Suits You

What is a medical billing process?

Briefly describing, it is a collaboration between the clinician and the insurance company resulting in proper payment for the service you provided to their client-‘the patient’. Medical billing companies act as a bridge between you two, to make the entire process easy and frictionless.

Why is a professional biller an indispensable commodity in your practice?

The billing process in itself is quite arduous; its regulations being so complex and subject to revisions from time to time. Often it turns exhaustive to your staff to keep up with the workload and takes their attention away from caring for the patient. Implementing additional manpower for coding and billing may not be always cost-effective. Also there is the requirement of having them trained and updated to the electronic medical recording system. It is highly recommended that you team up with some good Medical billing companies, if the bellow mentioned scenarios occur at your clinic

Frequently found dilemmas with billing in the day-to-day practice;

  1. Errors at the time of patient registration- name and other details
  2. Failing to evaluate the patient’s insurance eligibility prior to treatment
  3. Confusions regarding appointments, scheduling, rescheduling, cancellations etc.
  4. Missing out on collecting payment/co-payment from the patient
  5. Errors with coding and billing
  6. Improper/incomplete claim submissions
  7. Failing to keep track of the payments due
  8. Under billing /excess billing
  9. Missing/incomplete/ambiguous health records
  10. Lack of follow up with claim denials
  11. Profit/expenditure mismatch
  12. Lower turnover rate despite the hard work put into patient care

How to choose the company that fits your practice?

Even though Medical billing companies can boost your revenue and shape up your practice, it is crucial to choose the legitimate one. Joining forces with the wrong company will not only make you go bankrupt, it will also affect your reputation.

Finding a well-established professional company that supports you practice can be hard but here are a few tips;

  1. Look for quality of work- Only best in the business can take pride of quality in their process. Make sure that the coding and billing are done by certified professionals
  2. Promptness of delivery – faster payment cycles make most revenue
  3. Cost-effectiveness- Compare the cost of having in-office coders and billers to having the service outsourced
  4. Customized approach- Look for a company that matches your needs. Size of your practice, number of claims to be dealt with are to be considered too
  5. For speciality practices like physical therapy a different pattern of billing may be needed involving functional limitation evaluations and likewise. Experience in all areas of coding is a must
  6. Maintaining compliance – with local insurance payers, their policies and the trends in the area
  7. Self-updating – Make sure the staff are in the loop, when changes happen in billing/practice regulations
  8. Latest technical backup- Hire companies that team up with most advanced practice management software’s. Having the process automated makes everything quick and streamlined. It can cut the clutter from your daily practice beyond your imagination
  9. Reviews from other physicians- Listen to you peers for their experience in boosting their practice with specific billing partners
  10. Result oriented support- Ability to look at the revenue process with an analytical eye and provide you with constructive feedbacks

Process flow at professional billing services

  • Starts when an appointment is scheduled at the front office with a phone call from the patient – Details of their insurance facility are collected, pre-checked for eligibilities, preauthorized and treatment charges pre-negotiated
  • At the time of visit, ensure completeness of the health record regarding diagnosis, lab reports, radiograph reports, procedure notes, follow-up plans etc. ; and coded by professionals ensuring standard coding practices
  • Bills are processed based on the codes according to the billing policies issued by the government and insurance companies
  • Preparation of an electronic claim request, scrubbed to make sure it’s complete and error free for claim approval in the first round itself
  • Keeping track of all the payments due and the status of claim applications
  • Payment collected and recorded from approved claims and reimbursements
  • In case of denial/ rejection of claims, inquire on the reason for denial, make the necessary correction for resubmission, design an appeal and manage the payment process at the earliest
  • Evaluate the revenue cycle for errors in the system, quantify them and help revise the process to improve inflow of money

In hindsight, the staff at your clinic should not be burdened with endless typing jobs, preparation of claims, getting lost in the insurance hassles.  Their role is to be there for the patients, educate them, make them comfortable and respond to their queries. In the long run, these are the details which brings character and fame to you clinic. Good patient satisfaction is the key to increase in claim volume and profitability. Team up with smart Medical billing companies to have your performance tweaked to perfection.

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