How to Outsource Medical Billing Services to the Right Company

It is important for medical clinics and health centers to maximize their reimbursements to ensure they do not lose money and at the same time remain compliant. Medical billing and coding normally entails reading notes and medical files of medical practitioners and translating the prescriptions, diagnosis, and services provided into the appropriate codes for purposes of insurance claims.

A medical billing service provider submits the claims to the insurers and follows up on any denied claims. Medical billing mainly involves talking to insurers on phone to follow up on late payments or denied claims.

Outsourcing medical billing and coding eliminates stress and headache involved when performing these functions. It is highly advisable to leave such tasks to the experts. Here are tips for choosing the right billing services for a health center or clinic.

Sympathy & Diligence

All health providers should get paid for services rendered based on clinical guidelines, medical necessity, patient eligibility and benefits and reimbursement policy. The billing and coding company must be willing to fight so that claims are paid appropriately and reimbursements are done in a timely manner.

Good, Verifiable References

References are crucial to vouch for the billing company’s credibility. Whatever claims they make about themselves and what they intend to do in order assist the clinic or health center with billing and coding must be backed by verifiable and credible references.

Give Value & Offer Extra Benefits

A good billing service should do more than just entering charges, collecting money and getting paid by percentage. They should also be able to go for the extra mile to take care of the health center or clinic. For example they should check if the claims are properly coded and billed or whether all services and number of units are billed.

The company should have the knowledge and experience to put extra values in their work. They should be able to recommend a better method of billing and coding and educate the clinic or health center based on their knowledge from school and real hands-on experience. It is often a good idea to ensure the billing service provider has coding certifications. They should therefore be willing and in a position to offer free consultancy and support at no additional cost.

A Specialty-Focused Approach 

Select a billing company with years of experience in the health center's or clinic's area of specialization. This will ensure reimbursements are maximized and are also in line with the proper guidelines.

For instance if it is a cardiology clinic, the right billing service is one that has an existing cardiologist client or has vast experience providing an effective cardiology billing service. The billing company must have the ability and experience to read and properly process medical documentations relevant to the health center or clinic, for instance lab results and various progress and diagnostics reports.

This guarantees that money is not lost and yet compliance is maintained. The billing company should also provide comprehensive monthly reports for example productivity reports and patient and insurance balances aging analysis

Keenly Look at the Numbers

The medical billing company must be conversant with insurance EOBs (explanations of benefits). The company should know how to recover all underpayments and appeal for claims that have been denied erroneously. They must know about the health center's or clinic's contract rates and make a judgment on when is the right time to renegotiate the fees. They can offer guidance on how to negotiate for fees or even do the negotiations at no additional cost.

Access to the Clinic's or Health Center's Account

The billing service should allow the clinic or health center to get full and secured access to their account anytime. They should also give full access rights where one can, for example, look up all patient accounts and print reports. In addition, a billing company of good repute will prepare and send frequent patient statements, for example every fortnight.

Reputation of Quality Customer Service

The billing company must have excellent customer service. It should be accessible on phone or have a turn-around time of less than 2 hours when responding to an email or phone call. Preferably, it should provide one team leader or contact person to handle the health center's or clinic's account.

The Business Behind Starting a Medical Practice

The prospect of establishing a health and medical practice business model can be brightened or dimmed by the nature of the market, the ingenuity of the entrepreneur, levels of capitalization, and other commercial dynamics. Renowned entrepreneurs in the health and medical fields achieved their successes on account of their exceptional strategies born out of their devotion to offer quality health services at a profit.

One of the most important factors to consider before starting a health and medical practice is the type of services to be offered. Experts in healthcare entrepreneurship usually begin by considering the range of services in order to determine the level of capitalization required. Moreover, drawing such limits helps in deciding the amount of space required and the type of equipment to be purchased. At the onset, the entrepreneur should enlist professional help in designing workflow processes.

Keeping Patients' Records Organized & Accessible

Record keeping is a core process in healthcare entrepreneurship. Inappropriate handling of patients' information can compromise the quality of service and expose both the patients and the institutions to significant inconveniences. The records may include information on the dates of admission, discharge, type of care, demographic identities of the patients, and other details that appertain to their needs.

Such information is necessary for future references or for making referrals, as some situations might require. It is advisable for healthcare entrepreneurs to hire experienced professionals to lay grounds and undertake the process of record keeping.

Medical Billing Solutions: Challenges and Options

In the opinion of many experts, medical billing remains one of the most challenging processes in healthcare institutions. The challenge is common to both established and new institutions, but new units are more likely to encounter the severest kinds of billing problems. Delays and human errors are some of the most common billing problems that afflict newly established medical businesses.

In times of an influx of patients, many healthcare and medical institutions encounter problems of billing the patients in a timely manner. Because of this shortcoming, some institutions have chosen the alternative to outsource medical billing services to a professional provider. Established outsourcing firms rely on automated billing solutions that lower the levels of susceptibility of the system to errors. Also, many medical billing providers specialize in certain forms of billing for specialized practices. For instance, a surgical practice should seek a company with expertise in surgery billing, while a Federally Qualified Health Center (FQHC) can find firm that specializes in FQHC medical billing solutions

Accounting & Financial Upkeep

Primarily, a health and medical enterprise is established with the objective of making profits. As such, the accounting processes of the business should be managed with utmost professionalism in order to show the financial health of the institution, from the moment of capitalization to subsequent business processes.

The role of accountancy within the firm should be conducted in accordance with applicable international standards regarding the treatment of operational expenses, cash flow, profits and losses, revenues, and all other financial processes within the firm. The institution's ledgers, cash book, and other important records must be updated with professional discipline.

Marketing & Reputation Management

Once a health and medical institution is established for commerce, it becomes necessary for the managers to employ the most effective marketing strategies that can guarantee a competitive edge and elevate its reputation. Like any other field of business, commercial healthcare is highly competitive as investors continue to invent result-oriented marketing approaches.

In order to enhance the chances of success, it is advisable for the management to rely on a combination of conventional and modern marketing strategies. Surveys have shown that conventional marketing processes such as print and electronic advertisements can enhance the market reception of a new business venture when combined with modern marketing strategies such as social networking and content marketing.