When the business of medical practitioners grows they usually have to decide whether they want to manage their billing in-house or through a vendor. While many people are misled into believing that inhouse medial billing gives you more control over your operations, with the rise of medical billing services providers, a lot of practitioner’s resort to them to streamline their operations. Medical billing is paramount to the financial health of a clinic, which is why it is absolutely crucial to be mindful while opting for a service provider and take the necessary features into consideration. Some of the things that should not be forgotten while evaluating medical billing services providers are given below:

1. Level of service

Before you choose a medical service provider, the first most important thing to consider is the level of service provided. Start off by investigating whether the billing company is going to help you pursue denied claims or not. Denied claims need the intervention of a billing expert so that he can find out the mistakes that were made in the previous bill and rectify them so that the claim doesn’t get denied again and the practice is paid instantly. If the billing company does help in pursuing denied claims then they need to be informed of the procedure that is followed by the company for this purpose so that the payment of lip-service is avoided.

Secondly, the provider needs to state whether he will provide billing follow up services. Let’s say the patient doesn’t pay his bill and it has been quite some time since the bill is pending. In this case, who will follow up? Would it be someone from the clinic or an executive from the billing company? This needs to be assessed before partnering up with a billing company. Additionally, you need to assess how compliant the service provider is. This is because when a medical center outsources its billing operations, the billing company gets its hands on valuable and sensitive patient data. The provider needs to comply with the HIPAA act, which means that the billing company should protect the information of the patient as if the primary responsibility to protect it falls on their shoulders. Lastly, a medical billing service provider ideally has years of experience. Based on that experience they can make recommendations for the customer to improve the health of their practice. So before getting onboard with a service provider, it is crucial to analyze whether the provider will offer reporting and analytical services or not.

2. Industry experience

Experience doesn’t only entail the number of years a person has spent in a particular industry. It also accounts for the familiarity a billing company has with particular operations. These particular operations are different for different practices, so it would be ideal to choose a service provider that has specialized experience in an area the clinic revolves around. In addition to that, certifications go a long way in adding to the industry experience of a service provider. If you want to dig a bit deeper, then you should look for a service provider that has onboard with him staff that is essentially certified by the American Medical Billing Association (AMBA). This certification increases the credibility of the medical billing specialist by promoting professional standards for billing.

Medical specialists having the certification of American Medical Billing Association (AMBA) are essentially knowledgeable in the following areas:

  • ICD-10, CPT4 and HCPCS Coding;
  • Medical Terminology;
  • Insurance claims and medical bills, appeals and rejections, fraud and abuse;
  • HIPAA and Office of Inspector General (OIG) Compliance;
  • Information and web technology; and,
  • Reimbursement.

Although having a knowledgeable and certified staff is a huge plus, it is important to have the right technologies and follow the right procedures to ensure stability and the perfect outcome.

3. Use of technology

At times medical practitioners outsource their billing procedure primarily because they lack technology and the infrastructure to accommodate it. Let’s face it, spending so much money on hardware and software when you don’t have the space for it and the personnel to run it, would be a gamble that you’d most likely lose. So, it is always the right choice to outsource when it comes to technology. With that in mind, you need to assess whether the service provider has the right technology to propel your operations or whether they will just become a hinderance. Also, when it comes to evaluating the technology, you also need to make sure that the person operating it is equipped to handle it. Often times operations are assigned to individuals that don’t know what they are doing which leads to the bills coming out awry. While you are at it, also find out the billing company’s data security, information sharing and data backup procedures.

Here are the following questions you should ask in order to assess the technological capabilities of the billing provider:

  • How will the claims be shared?
  • Do the billing service provider’s ways fit with his electronic health record (EHR) strategy?
  • Do the services have an integrated EHR?
  • Does the service provider ensure data security?
  • What are the disaster management procedures?
  • How much data can be backed up?
  • Is there a software needed by the practitioner to avail the provider’s services?
  • Does the technology comply by the standards set by HIPAA?

4. Pricing options

Pricing options is last on this list because your aim as a medical service provider should be to get the best value for your practice rather than opting for a cheap service provider. You need to make sure that the services that you are going to avail correlate to the price that is being offered. If it seems too pricey then you can check out other providers that offer similar services for a lower price. in addition to that, you need to make sure that you are getting certified, experienced, compliant staff for your practice, for the amount of money you are going to pay.


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