Choosing the right medical billing company for your practice can be daunting. With so many options to choose from, partnering with the right company is crucial for your business. In light of the stiff competition in your industry, choosing the wrong company can become a costly mistake for your business. It is important to understand the factors you need to consider when looking for a medical billing provider.
Working with the right company will help you streamline your medical billing practice. It is understandable if you are having second thoughts about handing the task of medical billing to an outside firm. With the proliferation of medical billing companies, it can be hard to make an informed decision if you don’t know where to start. In this article, we will guide you on how to find the right medical billing company to partner with.
Steps In Choosing A Medical Billing Company
- Determine the scale of your practice’s needs
- Experience In Your Specialty
- Billing And Coding Training
- Cost Breakdown
- HIPAA Compliance
- Company Reputation
- Software Compatibility
- Process In Handling Rejected Claims
- Services They Offer
- How Many Billers Work On Your Account
Steps In Choosing A Medical Billing Company
Choosing the right medical billing company is not as easy as working with the first provider you come across. There are certain factors you need to take into consideration first before deciding on a medical billing company. This article will guide you on how to find the right medical billing provider for your practice.
1. The Scale Of Your Practice’s Needs
When looking for a medical billing company, consider the volume of samples and claims that your team is handling on a daily basis. Different providers handle different account sizes. Some can handle large medical practices with a huge physician network and accept different providers. Others can only handle smaller practices with lower budgets, few physicians, and few insurance providers.
Depending on the size, budget, and accepted insurance carriers of your practice, medical billing companies can fall into three categories:
- Small-scale. This type of medical billing company is suitable for practices with smaller budgets, data volume, and physicians. One benefit of small-scale billing services is that they can be more personalized and offer highly reliable one-on-one service. They are cost-effective and can save your practice lots of money on billing. However, you want to make sure that they have experience handling your billing needs.
- Physician Practice Management Company. This type of company provides billing services for practices with 200+ staff members. They are well-established and well-equipped in the medical billing and coding field. Physician practice management companies have the capability to handle very high volumes of data simultaneously. They can handle almost all administrative and back-office tasks for the physician. However, they can be costly as they will charge you for certain billing and coding services.
- Professional Billing Company. With a professional billing company, you can remove some tasks off your table so you can focus on patient care. However, they require a larger budget to avail of medical billing and coding needs. Make sure to ask for available plans, features included, and additional charges.
In addition, try asking about their current claims processing numbers, collection percentages and amounts, the number of employees they have, and the automation procedures they use. The most important factor to look for is the claims processing speed and collections percentage.
2. Experience in Your Specialty
When looking for a medical billing company, you will want a company with experience in your field to be your partner to ensure correct billing. Medical billing varies depending on which medical specialty one is billing for. Certain medical billing companies will be best suited for certain practices. While they may only have one area of specialization, they are experts in that field.
Working with experts in your field is crucial to your practice. Studies show that incorrect billing and coding are the top cause for denied claims and revenue loss. It is best to work with a medical billing company that focuses on your specialty. This way, you will know that the medical billing company will give their undivided attention to avoiding errors.
Make sure to ask specific questions like their specialties and subspecialties, the number of people trained in the specialty you require and build trust in what they are doing. If you are using certain technologies, ask the billing company if they have knowledge of the technology. Here are some questions you can ask to help you gauge the billing company.
- Years of total experience
- Staff training
- Number of billers who will manage account
- Updated billing and coding
- Billing and Coding Training
Another important factor to consider when looking for a medical billing company is their billing and coding training. You want to make sure that the provider is training their staff about ICD, CPT, HCPS, and CDT coding. In addition, you also want to make sure that they are updated with industry guidelines and regulations.
Compliance with rules and regulations is vital in ensuring that your practice stays in business and becomes successful. Check with the medical billing company how they stay compliant. You can ask them for the list of training seminars their staff has attended to stay updated. Regulations are constantly changing and it is hard to keep up on your end. That is why it is important to partner with a medical billing company that is updated with these changes.
Working with a medical billing company that is updated with the latest regulations will ensure costly delays or even denials. Check whether their medical billing team is AAPC or NRCCS certified. Staying updated with medical billing regulations will help you avoid any issues with insurance companies.
4. Cost Breakdown
Asking the medical billing company for a cost breakdown will give you a clear comparison and ensure that you are getting the best deal. Billing companies will either charge by percentage, a flat fee, or a combination. Look at your current patient load and get a rough estimate so you know what to expect.
Ask them about their current collection percentage as well as any additional fees or special service fees you have to pay for reporting and other informational services, and you should get a very informed estimate of your projected income. Asking for a breakdown will help keep your costs down and also give you an idea of what you are paying for each service.
Decide how you want to be billed. Would you rather pay by a percentage of revenue or a flat fee? You can narrow down companies by how they charge. Limit yourself to less than 5 companies so you will not feel overwhelmed by options. Always go for quality at a great price. Just because one company is cheaper does not mean the services are equal in quality.
5. HIPAA Compliance
Patient data security is a major concern for any healthcare practice. Thus, you want to make sure that the company you are partnering with is HIPAA compliant. This is important in ensuring the confidentiality of sensitive patient data and preventing personal health information from getting into the wrong hands. What data security policies and processes do they have in place to protect customer information?
Medical billing companies are expected to deal with patient’s confidential medical information. HIPAA compliance will make it easier for patients to trust you which is important in retaining their loyalty to your practice. Working with a HIPAA-compliant medical billing company means that you won’t be subjected to any punitive action when a breach occurs.
Also, HIPAA compliance means they will be able to handle your data properly. You want to give patients the assurance that their personal information will be protected and will not fall into the wrong hands. HIPAA compliance will significantly contribute to the growth of your organization.
6. Company Reputation
When choosing a medical billing company to work with, consider their reputation in the industry. Nowadays, there are many scammers in the industry and you do not want to get stuck with those firms. Making sure the company has a good reputation is crucial to your practice. Go online and check reviews about the medical billing company. You can ask questions like:
- Did prior clients have a previous experience with the company?
- Did they deliver on their promise?
- Did prior clients experience any error that resulted in revenue loss?
Ask them for any testimonials or reviews that can vouch for their work. 94% of healthcare patients use online reviews to evaluate providers. So if the medical billing company you plan to work with cannot show any review or testimonial, then move on to another provider. Check the credentials of the medical billing provider.
By checking the reputation of the billing company, it will elevate the level of confidence of your patients. Also, it will build confidence with insurance providers in approving medical claims that the billing company forwards to them.
7. Software Compatibility
Another important consideration when looking for a medical billing company is software compatibility. Transitioning to a new software can slow down your operations. It should be compatible with your current software. Depending on the kind of reports you create internally and the purpose of the system, finding a compatible software can be time consuming and costly on your part.
Also, using a new software may involve a huge learning curve as you will still need to train your colleagues and staff on how to use it. Check with the medical billing provider if they will train your employee with how to use the software upon signing the contract. Better yet, go for a medical billing company that offers software your staff is comfortable with the user interface.
You want the medical billing company to help make your workflow as easy and seamless as possible. If the software they are offering will seriously disrupt your workflow, you are better off looking for another provider.
8. Process For Handling Rejected Claims
Did you know that 65% of medical billers never edit and resubmit rejected claims? This could be disastrous for your practice as it could lead to a significant loss of revenue. Thus an important consideration when looking for a medical billing provider is how they handle rejected claims. What is their process in handling & resubmitting rejected claims? Additionally, you also need to check their rate of rejected claims. A high volume of rejections or denials from insurance companies means something is wrong with their billing and coding process.
There are several reasons why billing claims are rejected and it could be any of the following:
- Missing information
- Duplicate claim for service
- Service is already adjudicated
- Services not covered by payer
- Filing limit has expired
No matter how meticulous you are in handling claims, there will always be instances of claim denials. Checking details like accuracy of patient information, insurance and eligibility, and other issues can be daunting and time-consuming so you want the medical billing provider to have great attention to detail and spot these inconsistencies with the claims.
When looking for a medical billing company, make sure that they have knowledge of accurate coding. This entails ensuring that their codebook is updated. It is considered a felony to make fraudulent claims when receiving payment for healthcare services. So make sure that the medical billing provider has protocols in place for reducing risks and liabilities.
9. Services They Offer
When looking for a medical billing company, you should be aware of the services they offer as well as the services they do not provide. It is likely that the provider does not cater to some of the tasks you are handling. This will help you avoid any confusion or mishaps related to your service.
At the same time, don’t choose a service based on cost. Don’t assume that you will get a better deal from a discounted vendor. If the offer looks too good to be true, investigate and check the deal again. You might be better off looking for another provider to work with.
Check the range of services that you offer and assess which tasks you need help with. Will you have them help you with patient billing or sending statements? Do you need their help in forwarding uncollected accounts? Evaluating your services is an essential step in choosing the right medical billing company.
10. How Many Billers Will Handle Your Account
Another important consideration in choosing a medical billing provider is the number of billers who will handle your account. Some providers will assign just one per account while others will assign several. Each has its pros and cons so weigh your options carefully.
With just one biller, you can have a more personal relationship and they can give you undivided attention. However, you can get more work done with several billers handling your account. It will largely depend on the size of your practice and the relationship you want to establish with the biller.
In addition, you also want to find out the credentials, years of experience, and specialty of each biller handling your account. This will help you determine whether the billing company is a good fit for you.
Choosing a medical billing company to assist you in your practice can be a daunting task. These tips will help finding the right medical billing company to partner with much easier.
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