The decision to outsource billing services for your medical practice can have significant impact on your practice as well as revenue by freeing up more time for your patients and saving you the hassle of managing an internal billing department, if you are successful in choosing a professional and experienced billing service.

It can be an uphill task finding the right service provider to manage the revenues for your company. In this post, we’d share the top 5 criteria that can help you make the right choice.

Quality and Level of Services

The basic services provided by a medical billing company include claim generation and submission, following up with carriers and preparing patient invoices and providing patient support.

Many companies also offer extras that can make your revenue collection system much more efficient.

  • Payment follow-up – Many billing companies follow up with patients who do not pay their bills on time, crucial to optimum revenue collection for your practice.
  • Denied claims – What are the procedures in place for following up on denied claims?
  • Practice Management – Many billing service providers report back on monthly basis on billing issues and provide insights and feedback for improved practice management.

Before selecting a medical billing service, you must agree on the level of services provided by the company for smooth functioning.

Use of Latest Technology

Latest medical billing software offer many advantages, provided trained staff is available to utilize the technology.

  1. What are the procedures in place for data backup, data recovery, patient information sharing and handling and security of data?
  2. Is the technology HIPAA compliant?
  3. How are the superbills and claims shared?
  4. Is the billing service in line with your company’s Electronic Health Record (EHS) system?
  5. Does the service provider have an integrated EHR system?

Quality of Billing Staff

Apart from the number of years the billing company has under its belt, the experience and expertise of the staff is also important.

The staff must be aware of your specialty-specific codes and procedures employed by your company as well as the carriers. Staff experienced with Medicaid or Medicare would definitely increase operational efficiency.

It is also worthwhile to check for AMBA (American Billing Medical Association) certification that tests the staff for knowledge on coding, medical terminology, HIPAA compliance and carriers.

Consider Pricing Options

Various price models are available and the choice ultimately depends on the size of your practice, average claim size and volume and the service package provided by the billing company.

  • Percentage model – In this model, the billing company will charge a percentage of the total collections. It is one of the most popular models as it provides incentive to the billing company on the basis of the revenue collected.
  • Fixed fee model – Here, the billing company will charge a fixed amount for each claim submitted by it. This can turn out to be a lesser expensive model, but isn’t very popular with service providers due to lack of incentives.
  • Partly fixed model – It is possible to have a flat fee model for certain carriers and percentage basis for others. The method is not very common, but can prove to be more cost effective than a purely percentage based model.

Check out the Company is Certified

The billing company must be HIPAA (Health Insurance Accountability and Portability Act) compliant and protect the patient’s personal information in alignment with your company standards.

The staff must also be AMBA certified. To maintain AMBA certification, 15 continuing education credits are required each year.

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