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Taking a Look at Medical Billing Services – What You Need to Know


One thing you might be hearing more and more of these days on a national scale is that healthcare costs are rising exponentially in America. You have also probably learned that the United States is the most overpriced country in the world when it comes to medical care. However, what you might not hear very often is details about what happens behind the scene, especially when it comes to medical billing services.

It’s very easy to make assumptions such as these when you don’t know for a fact how the system works. Who gets to say for what we pay? How are we expected to pay for all this?These are questions hanging on everybody’s mind nowadays. To be able to lift the veil a tiny bit, this article will focus on medical billing services. What they are, how they work, how do they impact the patient, and if you should go for them or not.

What Is Medical Billing?


The first thing you need to understand regarding the whole process of medical billing services is that your practice is a business. Even though you are a doctor and you are trying to help as many people as you can and save their lives, you are still running a business. This idea means that you need to make sure someone pays you for the services you offer.

Once you understand how important this is, you will be faced with the following decision. Do you take care of the medical billing in-house or do you hire a team which will oversee all your billing?

Keep in mind that medical billing is the process through which a service, you as a doctor, has provided to a patient transforms into a billing claim. The equation is rather simple here. If you fail to file a claim, you will not get paid for said service. When it comes down to this, you can easily see how taking care of your medical billing in a professional way becomes a rather serious issue.

Medical Billing Services vs. In House Medical Billing

Keeping all the above in mind, which solution do you choose? Do you outsource it to a team of professionals or do you keep it in the family, so to say? If you go for the latter, you will need to learn how to master specialized software.

This piece of software needs to stay on top of your patients’ balances and to send bills to the responsible payers. Apart from that, you will need to hire some specialized staff which can run this software and manage the cycle at all times.

The third thing you need to keep in mind when opting for in-house medical billing is that you and your practice will be directly responsible for any rejected or denied claims.

The regulatory framework is always changing, so you need to stay on top of that as well. For example, October 2015 brought on a transition to the far more intricate ICD-10 coding. If you decide to engage in this process by yourself, this is something you will need to know.

The pro when it comes to in-house medical billing is the fact that it is indeed a lot cheaper. The con though is the fact that it is extremely time-consuming. You will also especially need to train your staff or yourself to be able to do it.

When you look at things in this light, medical billing services become the savior solution. They typically consist of a third party company. For a fraction of your collection, this firm will take over your billing cycle and manage it to perfection. As a consequence, you and your staff will be free to focus on the practice and the patients rather than on paperwork.

Apart from that, if you manage to find a reliable medical billing service, it shall serve other purposes as well, such as the following.

  • Increase your collection rate.

  • Reduce denials and rejections.

  • Provide you with an analysis and a report of the accounts receivable.

Still, how does one know which medical billing service to trust? This question is an excellent one which brings us to our following topic.



How to Choose the Best Professional Medical Billing Services



If you are in the business, you might already know that there are literally thousands of professional medical billing companies out there. However, since you are looking for one in which you can place all your trust and your money, how do you go about choosing?

Most experts in this domain state that you shouldn’t walk the trail of selection by yourself. It can and it will get tricky to find the best medical billing partner for your practice. What you can do is find a professional consultant in your area. He or she knows these third parties by heart and will be able to locate a suitable partner for you.

However, if you don’t want to employ a consultant, you can do it alone as well. Here are a few things you need to consider when thinking about hiring a professional medical billing company.

  • How much will it cost you?

  • One cannot quantify the costs themselves without further personalized details. They will vary widely, depending on the size of your business and its particular focus. If you want to know beforehand, you will have to call in and discuss it with a sales representative. There are also some websites which provide an estimate. Still, keep in mind that it is only an estimate.

    The best part of all, medical billing services charge four to nine percent out of your total income per month. Seeing this is quite a high sum, ask them the following questions.

    • What services am I getting for this percentage?

    • Are there some clearing house payments in this amount or will they be charged additionally to my business?

    • Will this rate include the co-pays which my staff might be collecting at the time the company renders these services?

  • What services are you getting for your money?

  • This aspect is yet another crucial one. The main reason is that there are no two medical billing services alike out there. For example, some will scrutinize your claims and make sure they follow up with the insurance company so that you get your money. Others will also analyze your accounts payable periodically.

    Some others strive to give you recommendations on how things could be improved and so on. You need to perform thorough research and find the best professional medical billing services that suit your needs.

  • What level of support will you be getting from the medical billing service?

  • Needless to say, no matter which service you choose, you will want it to be a communicative one. The third party must keep you in the loop at all times and not make any decisions without your agreement. That should not be a difficult thing to achieve, as most third-party companies use software which is reasonably transparent. This idea means that you, as the patient, have the opportunity of overlooking everything they do, at any given moment.

  • Will they be engaging your patients?

  • You are not the only person whom the medical billing service needs to keep in the loop. The patients’ presence is just as necessary. However, the level of engagement depends on the company itself. Just as you might have expected it, some tend to relate more to the patients than others. All you need to do here is to see just what level you think would be best for your practice.

Tips from Other Clients

One of the best things you can do when it comes to finding and hiring a medical billing service is to listen to what others have to say about it. Here are some tips from other professionals which you might want to take into account.

  • Once you’ve chosen a company, try to talk to some of their other clients. Ask if the company has made any mistakes so far and what they were.

Some might tell you that they haven’t made any mistakes as of yet. That is not even remotely true. When it comes to medical billing, everyone makes at least one mistake.

The interesting thing here is not the fact that they make mistakes or not, but how they manage them. This is what should concern you.

  • Make sure the one you choose has experience in handling medical bills in your particular field. If you’re a gynecologist, then your statements will differ significantly than those of an oncologist’s.

  • Does the medical billing service you’ve chosen have the ability to handle not only the revenue cycle but also the legal implications? Keep in mind that if they make a mistake you will be held responsible, not them.

Choosing a medical billing service is one of the most challenging things you will have to do business-wise. Choosing the perfect one will be one of the most rewarding, though.



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