Medical practices need to be extra cautious and must consider various factors before contracting out billing service to a third party medical billing company. A bad hire can put the practice in jeopardy and can cause serious problems. However, a professional medical billing services provider can help to maximize collections and improve the overall efficiency of a practice. But how to ascertain that a specific medical billing services provider is the perfect match for your specialty and engaging them to manage billing would boost collections.

medical billing

Most of the decisions when hiring a third party vendor are made based on cost and budget. However, higher service charges do not that guarantee that the vendor is better than others and the same is true of companies that charge lower than others. The cost of services is one factor that looks important but must not determine the quality of the services that you would get.

An outsourced billing partner at higher rates can be equivalent to a provider that is charging 4% to 5% of collections. So, what are other factors that practice should consider when hiring a billing services provider? Below is the checklist of features and capabilities of billing services providers that can help you reach the right decision of finding the perfect match for your specialty.

Certified and knowledgeable coders

Medical coding and billing are different from simple outsourced office work. Before engaging with a medical billing provider, you must ascertain that the provider has a sufficient team of certified coders and billing professionals. Only certified coders can perfectly understand the requirements and can accurately prepare the claims. You can ask for the professional certifications of the coders and if they have been accredited and certified by any training and certification association such as the American Academy of Professional Coders (AAPC) or by the American Health Information Management Association (AHIMA). This would ensure that you are handing over the billing to professional coders who are not only trained to perform the job but also have the expertise to handle billing. You must also check if the coders are trained to handle the latest version of the International Classification of Disease (ICD) codes and are updated with the recent changes and modifiers.

Compliance with security standards

The security of the health records and personal information of the patients is something that is constantly pestering healthcare services providers. Hacks and data leaks are costing billions to the health industry and healthcare providers are also bearing huge penalties in case of data leaks.

Outsourcing billing means that you are handing over the private information to a third party and if the vendor is not compliant it can be risky. Thanks to the rules and standards set by the Health Insurance Portability and Accountability Act (HIPAA) which outlines that how to ensure the security of the health records and what precautions healthcare providers must take when disclosing health records. You must ensure that your billing partner is under HIPAA certified compliance. You must choose HIPAA compliant billing partner as it will ensure that they are maintaining higher standards to ensure the security of the data and all their processes are in accordance with the rules and regulations.

It is an obvious fact that HIPAA compliant billing companies keep higher standards, leave less space for errors and omissions, boost collections and make you least vulnerable to data hacks.

Previous experience and reputation

It is always better to engage with an experienced medical billing company. Although, many fresh entrants would try to lure you with a lower percentage their inexperience would cost you more in the long run.

If you are outsourcing for a longer-term then you must ask for the experience of the billing services provider and when experience in serving the same specialty as yours is a plus. You can further probe what clients they have been serving and what is the feedback of their clients. You can also evaluate based on the review they get from their clients and can determine their reputation.

Transparent costing

Sometimes it is difficult to understand for providers to calculate the exact cost of outsourcing. Billing providers can trick you paying more by revealing the hidden fees or charges afterward which you were not sure of in advance.

Before signing the contract, carefully read every particular detail which is related to costing and inquire about that from the vendor. Ask them about the fee structure, percentage, and how they would charge for the service. To ensure the transparency of the services provided, many billing companies give access to their system where the medical practice can check the status of the claims and can download periodic reports.

Software and automation tools

If you are already using software tools and electronic health record systems to manage clinical processes and billing then you must communicate it to the billing company. You must inquire if they can integrate their system with your software.

The knowledge of software technologies and automation tools is a must for the billing services provider. Take confirmation of their experience in managing billing software and what technologies they would be using. Good billing companies remain flexible and scale up their resources according to requirements. You must ask about how they manage data, archive it and would share it with you.

Outline services

Confirm in advance about what services the billing vendor would be providing. Medical billing is a large task and involves various processes and you must outline the scope of services before moving on.

Typically, the medical billing services provider should be capable of verifying insurance eligibility of the patients, demographic data entry, ICD/CPT coding, charge posting, claim scrubbing, electronic claim submission, claim follow-ups, denial management, payment posting, patient statements, and reporting. These are the basic services that your billing partner must provide and you can expect more from large billing companies as well. Ideally, the vendor must update about the account receivables, payment status, performance indicators and assistance in revenue cycle management.

A good medical billing service provider should assist a practice in maximizing its collections and achieving its revenue targets. They should remain easily available with a dedicated support team to answer your queries. Transparency in processes and consistent support and communication is the key success when engaging with a billing partner.

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