When a medical practice takes that necessary step towards outsourcing their medical billing, the key priority is to choose a reputable company that they can trust 100% with their patient’s medical information. A physician needs to ensure that they engage a company that will be able to significantly reduce the headaches around billing issues, while at the same time protecting and securing their patient’s private data. A great choice will allow the physician to spend more time on his patient’s care and fewer hours on time-consuming billing rigmarole. So, how do you go about evaluating medical billing services?

The right service should:

  • Be established with verifiable industry experience. It’s not about the number of years in business but rather about areas of specialty. They must have experience as a medical billing service that is able to bill to Medicaid and Medicare.
  • Have staff members on the team that have been certified by the American Medical Billing Association (AMBA). This means they have in-depth knowledge of medical technology, ICD-10, CPT4, and HCPCS Coding as well as HIPAA and Office of the Inspector General Compliance – to name a few attributes.
  • Protect patient privacy by being 100% compliant with the Health Insurance Accountability and Portability Act (HIPAA)
  • Have a high level of service excellence. In the service level agreement make sure you are clear on whether the service will follow up on denied claims and unpaid bills.
  • Provide multiple support channels including email, phone, live, messaging, etc. along with in-person training or webinars to assist the provider’s staff on how to use their medical billing features and how to improve the practice’s revenue cycle.
  • Make use of the latest technology
  • Use a competitive pricing model
  • Not have too many clients on their books. They must have the capacity to execute the demands of your billing cycle timeously.
  • Share data on how to improve the practice. They will have reporting and analysis tools which could be exceptionally helpful to the medical provider. Be sure they are open to sharing their insights.

The functions you will need from an experienced medical billing service provider include claim generation and submission; insurance carrier follow-up; payment adjudication, posting and processing; patient invoicing; patient support and collection agency transfer services. These are the core elements of an efficient medical billing services company. The provider should be super efficient in pursuing denied claims. Following up with insurance carriers should also be one of their fundamental strengths.

Many medical billing service vendors offer a range of other features including appointment scheduling, insurance eligibility verification, credentialing and medical coding. The more services are chosen, the higher the fees. The choice of items must be based on the cost as well as what the physician can realistically execute in-house and what definitely needs to be outsourced to ensure the practice can run seamlessly. There are three price structure possibilities – percentage-based, fee-based or hybrid (a combination of percentage and fee-based).

Once a provider chooses an outsourced medical billing service, the next step is to measure their performance. After about 4 months on the job, go back and do a charge capture audit on their work to date. Compare the log of your registered patients from all of your locations, and see if all procedures have been accounted for during this time. Doing a spot check is vital to reduce revenue leaking. No-one wants to be completing procedures that never make it into the billing system!

Another area to evaluate is the medical billing services coding accuracy. Is the company using an auto-coder and how often do they audit their coders? Are all of the physicians using the appropriate codes in the practice to ensure maximum reimbursement (under-coding can lead to noncompliance)? The billing company should be revealing a 95% and upwards accuracy rate (according to Health Management Technology).

It is important to know how your medical billing service monitors underpayment? To make sure a provider is being properly reimbursed, they need to be privy to the payer contracts that have been negotiated. The billing company should be delivering at least 80% of the expected collections every month. That figure is a good indication that their operational process is well oiled. It is essential to know how the vendor handles manages denials and what process they employ to report them to the provider. The reports the vendor submits should detail denial trends by the denial code. Once these denial reasons have been analyzed, they should furnish an improvement plan on how to reduce them. This is the crux of evaluating the medical billing service’s performance.

The medical billing service does all of the heavy liftings and can free up a massive amount of time that could be better spent on seeing more patients in a day – that is of course if you make the right choice upfront.