5 Things to Remember Before Outsourcing Medical Billing Services

Medical billing services are more of a conundrum in present times because the process has gotten more complicated with time. The government has set value-based criteria for the providers to follow, for ensuring a productive health system while cutting costs.

The volume-based reimbursement model is long gone when the providers were paid according to the number of patients.

Patient-reported outcomes matter now and to improve those outcomes, CMS launched EHR Incentive programs earlier and currently successful MIPS implementation holds the key to success for the eligible professionals.

If providers do not adhere to the Medicare and Medicaid EHR Incentive Programs, there are penalties in the form of negative payment adjustments. The Medicare EHR Incentive Program dissolved into MIPS as one of its essential performance categories.

What is medical billing?

Medical billing is paying the health professionals for their services rendered to the patients.

It is a process that starts with a patient booking an appointment with a doctor, the doctor tending to the patient, diagnosis, and treatment. It also includes creation of the medical bill, submission of claim with the payer and finally ending up when the payment reaches the doctor’s bank account. This one cycle of cash flow is a 'Revenue Cycle'. It is not as easy as it sounds.

The outsourcing reviews speak highly of National Medical Billing Services as a reliable company and P3Care as an emerging organization. Do remember the following things before getting involved with a 3rd party medical billing services.

1. Look for Experienced Medical Billing Services

First of all, it is better to hire a private medical billing company to do the job. It frees up your medical staff from undue burden. You need to have a background in IT before anything else to do the job of a medical coder. Experience is the first thing to look for in a company offering medical billing services. You can ask for proof of past work to back up those years of experience. You can contact those doctors or organization just to be on the safe side. It is a simple & efficient way of evaluating the authenticity of their services.

As a client, it is upon you to do your homework before making them in charge of your finances.

2. Ask for the Monthly Percentage before Signing Up

You must ask them about their share after approval of your claims. Hiring or outsourcing medical billing services often leads to an economic solution. It is one of the primary reasons; providers sign up with private billing companies. That and the fact, it relieves their localized staff from intense billing duties.

Most billing companies charge 7% of the total collections. It is the percentage-based payment model. There is another way of payment as well. It is the flat-fee payment model. You only have to pay for one bill at a time. Whichever method you choose according to your practice requirements, do fix an amount beforehand. Making it part of an agreement suits best with a company you cannot physically visit or meet over a cup of coffee.

3. Choose an RCM Billing Company

RCM stands for revenue cycle management. It is the cycle that executes and brings in the cash by pushing claims through the check & balance system of the insurance companies resulting in approvals or denials. Mostly, these medical billing services are only cycling the revenue isolating the big management part. Medical billing and management services include maximizing the billing codes in each claim to receive most favorable reimbursements. If you find an excellent billing company, you can ideally raise your revenue bar by 20 to 30 percent. And this is not even an exaggeration.

There are many medical billing services in California, and for them to play an active management role, they need to deliver results while streamlining the cash flows. A high first-time clearinghouse claim submission percentage gives them an advantage over the others.

4. Meticulous Coders

Expert coding staff means dealing with many complicated codes at once and having a good grasp of the thinking pattern and claims' scanning mechanism of the payers. They know by handle large volumes of claims about the possible reasons for claim denials. This intuitiveness attributes to filing a large number of bills and being part of the system for a long time.

5. Billing Operations Must Have Support of State-Of-The-Art Software Systems

The billing personnel must know their way around Health Information Technology (HIT). The cautionary bells and alerts in the customized software simplify the multiple stages of medical billing for them. Best medical billing services only hire individuals who pass their intense training and go through critical evaluation.

6. Cloud-Based Access to Clients

Not every company will provide this level of transparency in which the client can see the actual billing process. However, some companies do give cloud-based access to their clients so they can witness live business activity.

Reliable medical billing companies usually send reports promptly, so the clients know what’s happening with their bills and how much money is coming in collections as a result.

Not reporting at all makes a billing company vulnerable to losses in many forms. It can be a reputational loss to losing an actual client. Therefore, as a company providing medical billing services, you must properly document and take the client on board with regular presentations, communicating with them via conference calls or video meetings.

My focus on the a href=” https://www.p3care.com/”healthcare sector has made me look inside searching for compassion we all need to understand the endless relationship between patients, providers, and payers.