Your Medical Billing Service: What should you expect?

Uncategorized Mar 01, 2018

If you have recently outsourced your medical billing, or are expecting to outsource it in the near future, there are many important questions that must be asked. Not only is it important to choose a reliable, reputable, and effective billing company, but if the wrong billing company is chosen, it could have a severely negative effect on your bottom line, and possibly put you out of practice.

Because of this, it is important to know what you can expect from a good billing service, and make your choice wisely. 

  • Coding and charge entry: Will you code your own claims and enter your own charges? If not, then the billing service should employ a certified coder with experience in your field to work with you on proper coding of your claims. If you do code your own claims and enter your own charges, then the billing service should discount your rates, considering the less amount of work.

  • Claim management and follow-up: How does the billing company send their claims? Can they send both electronic and paper claims when necessary? Some insurances (like Medicare) will reduce payment rates, or deny claims entirely if they are not received electronically. Also, ensure that the billing service has a claims follow-up process in place. Will they send appeals when necessary? How do they identify claims that need to be appealed? How often do they follow-up on unpaid claims? In effect, how hard will they fight for you to get all of your claims paid sufficiently?

  • Patient billing and collections: Other services that may or may not be offered by your billing service are patient billing and collections services. Patient balances are always an issue, and unpaid patient balances must be sent to collections. If your billing service does provide patient billing, ensure that they have a way to send patients to collections, and then communicate this information with you so that further unpaid patient balances will not be incurred by the same patient.

  • Reports and communication: A very important service, which should be provided by your billing company, are regular reports and communication regarding your claims. The types of reports that should be provided are aged accounts receivable reports for both insurance and patient balances, activity summaries, practice analysis, and notes regarding unpaid claims, such as requests for medical records. Checking a billing services reports is the best way to assess the work they are doing for your practice, and ensure that they are working as hard as possible for you.

Your exact needs in regards to a billing practice will depend on the size of your practice, your medical specialty, and the complexities of your billing. These four components, however, should be addressed in all contracts with a billing service, and expectations regarding these four areas need to be set in your contract before the work begins.


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