Top Seven Criteria for Selecting the Right Medical Billing Service Provider

Outsourcing your medical billing and coding is a sensible solution to reduce your administrative costs, accelerate your cash flow, reduce billing and coding errors, process claims faster and maximize your revenue stream.

A large number of practices from all specialties are outsourcing their back-office operations to third-party billing providers and there is no end to it.

However, only the right medical billing services provider can increase your chances of achieving your bottom-line goals.

Since there are hundreds of companies offering medical billing services, choosing a vendor that can best suit your needs is the hardest part of the process.

There are several variables to take into account when choosing a medical billing company.

Here are some of the most important factors that you must keep in mind.

1. Expertise and Experience in Your Specialty

Every medical specialty is different and comes with its unique billing and coding requirements and challenges.

Whether you specialize in pediatrics, internal medicine, pain management, or psychiatry, it is important to look for a billing services provider that has experience and expertise in your certain type of practice.

This will make sure that the billing services provider will know the requirements of your specialty for documentation, coding and compliance, which will eliminate or significantly the likelihood of any billing errors that result in claim denials and an unforeseen loss of revenue.

2. Scope of Expertise

Make sure that the vendor you choose can provide an end-to-end revenue cycle management (RCM) solution, from before the appointment to of patient to the final claim reimbursement. They should excel in handling each phase of RCM, including claim submissions, Account receivables follow-up, payment processing, patient invoices, and more.

They should have resources to handle the volume of claims you practice deals with on day-to-day basis. This is especially important if are running a large-size practice.

Ask your prospective company how many claims they are currently processing and how many employees they have to manage the workload. This comparison will help you determine whether or not an insurance provider can handle insurance claims per unit of time that your medical practice is currently dealing with.

No matter what the how smaller or larger the billing company as compared to your practice, the things that will matter the most at the end of the day are the claim processing speed and percentages of collections.

3. Data Security

Like any other industry, data security is immensely important in the healthcare industry the light of a surge of cyber-attacks and the use of ransomware to steal confidential information.

When you outsource your medical billing to a third party, you trust your sensitive patient information and financial data with them. Any misuse of a patient’s private information may adversely affect the reputation of your practice.

Therefore, it is important to make sure that the vendor you choose can handle your information, both at rest and in transit, in a secure manner.

Make sure the security systems and processes of your potential company comply with regulations for data handling specified under the Health Insurance Portability and Accountability Act (HIPAA).

4. Transparency

When you outsource your medical billing, you will have to rely on your vendor to maintain the financial health of your practice. Therefore, it is important to assess the transparency practices of your potential billing services provider.

Delay in claim processing and lack of immediate availability of financial information are the two common problems that healthcare providers face after outsourcing their billing processes.

To ensure optimum transparency in your outsourced billing processes, it is recommended to look for a vendor that offers a cloud-based billing solution.

The cloud-based system allows you to log in from anywhere you want as long as you have a reliable internet connection, helping them monitor claims and check submitted claims, denied claims as well as the summary of payments and charges in real-time.

However, since the cloud-based solutions are still relatively new to the healthcare industry, not all vendors are accustomed to it.

Look for a cloud-based billing company that provides greater accessibility and the latest technology and offers additional security measures like frequent data backups for uninterrupted tracking of your billing operations.

5. Service Cost

While your decision to choose a vendor shouldn’t be based solely on the cost; it is still a critical factor to take into account.

You need to be clear on what you will get against your money. The price of outsourcing your medical billing can widely vary depending on the size of your practice and your area of specialty. Most of the service providers usually charge by percentage – which is usually between three to nine percent of net collections. Some companies charge a flat fee in addition to a small percentage of the practice’s revenue.

Here are a few things that you should ask your potential billing company concerning the cost.

• What percentage you will receive on the net receipts of the practice?

• Are there any additional such as startup, termination, patient collection fees, and data conversion?

• Does the amount you will charge include the co-pays of your employees at the time the service is provided?

Compare the rates provided by your outsourced medical billers between a few companies. It is recommended to keep this comparison between five or fewer companies.

6. Responsiveness and Customer Support

Responsiveness and availability are two major concerns for healthcare providers when deciding on whether or not to outsource their billing. Outsourcing your billing operations means you don’t have the privilege of just walking down the hall and passing out instructions for immediate implementation or get quick answers to any queries.

Ideally, your outsourced billing partner should be able to provide you with immediate assistance for any issue that you might come across at any time.

Therefore, it is important to ask your potential medical biller about how long it takes to respond to questions, phone calls, and service requests. Make sure that if you have an urgent question, your vendor can provide you with a response when you need it the most.

7. Compatibility with Your Existing Software

If you are already using software to manage your patient accounts, financial information, and other back-office operations, it is advisable to look for a company that is capable of handling software compatible with yours. Transitioning to a new system can slow down your day-to-day operations and require a lot of time and money. Additionally, your employees will have to receive training to get familiar with the new software.

Ask your billing services provider whether the contract will include training, and if it will be provided for free or a fee will be charged.

Furthermore, ask your billing company about the software it uses to let your employees get accustomed to its user interface. As a healthcare practitioner, you will want to maintain a smooth workflow without complications. Since you are outsourcing your billing operations to a third party, it is important to ensure that it is as easy and seamless for your employees as possible.

Final Words

Choosing a medical billing company is one of the most critical decisions you need to make for your medical practice.

Therefore, no matter what your specialty and size of the practice, it is important to do your due diligence and find a company that has experience working within your medical specialty, and possesses a solid track record as well as verifiable references.

The abovementioned tips will help you discover a perfect billing partner who will take care of the back-office operations of your practice as dedicatedly and diligently as you take care of your patients.

Albano is a passionate content creator and an enthusiast with a focus on misc. writing expertise.