Medical Billing Services Purchasing Guide
Making the decision to outsource your billing means that you’ll need to spend some time researching and evaluating medical billing companies. Not only do you need to find the right price for services, but also find a service that aligns with your practice goals.
Outsourcing your medical billing department is a good way to improve your claims management process and recover a lot of outstanding claims. Finding the right medical billing service will help you to improve the efficiency of your practice’s back office.
The Changing Healthcare Reimbursement Landscape
To maximize your revenues, look for a company that is abreast of current trends in healthcare reimbursements.
- Billing agents should be trained and should be well-versed in ICD-10 with its more than 70,000 billing codes
- The company should be fully-equipped to handle and manage EHR, electronic health records
- They must be able to provide strategies to manage your practice considering rising insurance deductibles and pay-for-performance reimbursement models
Weighing Financial Factors
What does it cost to operate your in-house billing department? Considering the cost of wages and salaries, equipment, and overhead, the annual operating costs of a billing department can quickly exceed $50,000. Outsourcing can provide a significant reduction in operating costs. When combined with increased cash flow from better revenue recovery, outsourcing can have a large positive impact on your bottom line.
What Are Your Options for Outsourcing Medical Billing?
Your two best options are your EHR vendor or a local medical billing company. Here are some of the benefits, and pros and cons of each type of business. They can work closely with your staff to implement procedures to continually improve the ability to maximize your practice revenues.
Local Medical Billing Companies
The primary benefit of working with a local medical billing company is their potential ability to provide on-site support during the transition phase and throughout of duration of your service contract. On the downside, communication between local billing firms and insurance companies is often phone-based rather than software-driven or online and can slow the process down. You’ll also find a lack in the areas of financial aging data, monitoring, and reporting.
Pros
- Easier to establish accountability
- Face-to-face relationship
Cons
- More difficult to analyze performance
- More expensive
EHR Service Providers and Vendors
The primary benefit of outsourcing to an EHR service provider is the higher level of integration and technology you’ll receive. Combining billing and records management services with a single vendor can text-base text-gray-900 to greater efficiency and additional cost savings. However, it can text-base text-gray-900 to more complex management issues. If problems arise, they will affect all your billing and records systems together. {' '}
- Pros: Software, service, and product integration
- Cons: Less flexibility than using separate service providers
Eight Things to Keep in Mind When Shopping for a Medical Billing Service
- Rates. Do your research to get the backstory behind a company’s service rates. Check pricing from several competitors and pay attention to the outliers. You may be tempted to eliminate the highest rate and go with the lowest rate. But, make sure you compare all the close competitors for value that goes beyond rate.
- What’s included in the rate? Make sure that a medical billing company is not offering artificially lowered rates that only include services that are far less than what is expected from a full-service third-party billing solution.
- Minimum billing requirement. Some companies require you to reach a minimum billing threshold to qualify for their artificially low service rate. You could end up paying rates that are much higher than industry standards and non-competitive with other medical billing service providers.
- Billing agreement structure. Does the billing company charge according to your existing practice revenues or based solely on the amount they collect? If a significant portion of your revenues come from sources other than what the vendor collects, then you’re overpaying for billing services. Look for a company that structures your fees based on their actual billing and collection activities. {' '}
- Contract length and term. Avoid signing a multi-year contract before you’ve had an opportunity to try their services out. Look for a medical billing company that offers you a one-year starter contract with preferred rates if you sign a multi-year contract thereafter. That way, you can evaluate their performance before making a costly long-term commitment.
- Denied claims procedures. Does the company only offer a one-time submission with no procedure in place for denied claims? Do they refer denied claims back to your office, or do they bill for each claim resubmission? If your office staff needs to spend time processing denied claims, you’ve just lost the benefit of outsourcing as you are now paying for both in-house and outsourced billing services. Look for a medical billing company that has a clear multi-submission process to handle initially denied claims.
- Performance guarantees. What type of performance guarantees do they offer, and how does it compare to competitors’ guarantees. If a company doesn’t offer a basic or minimum performance guarantee, they may not be a fit for your practice.
- Data ownership. At the end of your service contract, you’ll need to ensure that you own your data and can seamlessly transfer your services to another vendor or provider. Otherwise, you run the risk that they will hold your data hostage to prevent you from switching to another provider.
Some Final Thoughts
Make sure that your third-party medical billing solution makes your in-office procedures for submitting bills easy and not complicated. Less labor-intensive, more hands-off procedures are what will save you time and money in the long run. {' '}