Buying Guide for Medical Billing Services
Finding the right medical billing service for your practice is one of the most important decisions that you’ll make. The right billing service can completely transform the business efficiency of a medical practice. However, it is also challenging to find the right provider, because finding the fit between your practice and the options that are out there requires some research and checking of relevant reviews. That’s where we come in, and hopefully, these buying tips will give you some things to keep in mind as you research what medical billing service is going to work for your practice.
The guide will help you find the best Medical Billing Service to quickly recoup outstanding claims, improve claims management, and get the right price.
Changes in Healthcare Reimbursements
Doctors in America have been faced with some extreme technological and bureaucratic transitions over the last several years. Navigating these muddy waters can be confusing at the best of times. First, the transition to electronic health records (EHR) needed to be faced. This in itself provided a daunting task for many practices. Now however, the shift to ICD-10 provides an entirely new challenge. With more than 70,000 potential codes when sub-classifications are considered, any billing service that you consider needs to be fully versed in accurately utilizing ICD-10.
This is not an isolated event in the way healthcare billing is handled either. In some cases, the model has shifted to a pay-for-performance notion, in others, deductibles are on the rise, and in all cases, the way doctors manage their business has got to shift in order to stay current with the marketplace.
This is where finding a medical billing service to take over the management of this aspect of your business can be instrumental in the success of your practice. The best services in this area pride themselves on staying current on all developments in the field and training their agents to a high standard of proficiency in order to successfully manage your practice’s revenue.
Financial Considerations
One of the chief factors to weigh when deciding whether you want to outsource your billing or continue handling it internally is the cost savings that this option can offer your practice. Internally, it easily cost $50,000 per year (or more) to pay for internal billing. When you opt to have a medical billing service handle this task instead, your costs for this aspect of your practice are likely going to drop dramatically.
Options for Medical Billing Services
When you start the shopping process for a billing service, you have some general categories that you first need to choose between to help narrow down your options. Primarily, you need to choose between a local company, offshore company or your EHR vendor.
Local Medical Billing Company Benefits
• Face to face relationship
• Accountability
Local Company Drawbacks
• Lack of financial aging data
• More dependence on telephone contacts rather than software for connecting with insurance providers
• Less analysis of performance
• Often more expensive
Offshore Company Benefits
• Per-claim billing models available vs. percentage model used by most other providers
Offshore Company Drawbacks
• Communication difficulties due to linguistic differences
• Rotating support instead of a dedicated manager who can build a relationship with your practice
• Lack of regulatory oversight ensuring patient privacy in an increasingly tangled and consequential area of patient record management
EHR Service Benefits
• Higher end software and product integration
EHR Service Drawbacks
So, as you can see there are drawbacks and benefits to all kinds of companies that work in this part of the healthcare industry. Choosing the right type of company depends largely on what is most important to your company? Relationships with your vendors, pure savings, or ease-of-use and support?
Top 8 Tips to Keep in Mind When Shopping for a Medical Billing Service
- Ask about performance guarantees: Many of the great companies on the market offer a performance guarantee of some kind. If you find a medical billing service that doesn’t offer a performance guarantee, you might want to ask yourself why do they feel they don’t need to offer the same type of guarantee that so many of their competitors do.
- Low rates are not the be all or the end all: Just because a company has a price that is lower than some of their competitor’s rates, does not mean that they’re going to offer you the best value for your money
- Understand the terms of data ownership: No business relationship lasts forever. Always find out who the ownership of the data rests with. When the official data ownership rests with the service provider, find out what recourse you have for legal cancellation of your services, as in some bad situations, providers who have ownership of the data hold it prisoner when practices try to switch to a different provider.
- Understand the billing agreements: The billing agreements that are offered by different companies can range vastly in the terms they offer. The best companies that are out there should only charge you for the amount they actually collect for you – if they are offering to charge you based on your practice’s revenue, keep in mind that there may be billings and revenue streams that they don’t directly end up contributing to. This could mean a much higher cost for medical billings than you should need to pay to an outsourced company.
- Watch the terms of the contracts: If a medical billing service insists that you sign a multi-year contract before even letting you try their service, you might want to ask yourself why they are insisting on this? A more typical arrangement offered by those companies that have faith in their own services is a one-year contract. Then, if you’re satisfied with the performance that they’ve offered, you may have the option of obtaining a preferred rate if you commit to a longer contract.
- Do your research into what the rates include: This is a sneaky tactic used by many companies that aren’t as proud of their service offerings as they should be. They offer artificially lowered rates that look incredibly appealing, but only include a fraction of the services that are required if you want a full-service third-party billing solution. Make sure you understand exactly what you are getting for the money being promised before you commit to a service.
- Ask about denied claims or resubmission: Certain medical billing services will operate on a one-time-only basis for your billings. If a claim gets denied or needs to be resubmitted, they will instead refer the matter back to your practice, costing you time and effort for a service that you are already paying for. Instead, opt for a firm that will commit to these billings even when they aren’t solved in an initial submission.
- Consider minimum billings: This is another trick that some less-than-ideal billing services hang out as a lure. They may advertise what seems like an incredibly low rate for their services, but without discussing the minimum amount that needs to be billed in order to actually pay that low rate. Companies that utilize this model often set that minimum at an amount so high that very few, or none, of their clients will actually hit the threshold, resulting in everyone paying a much higher rate for their service.
These 8 tips all share a common theme: do your homework before you settle on a medical billing service. Some simple review reading before you contact a company can help you quickly separate those that operate on an above-board level with industry accepted practices, from those that are trying in a potentially underhanded manner to extract more money from your practice.
Final Thoughts On Finding A Great Medical Billing Service
There are a few final things to consider when finding the best billing service for your business. One thing to keep in mind is that to get real value for your money, you want to be as hands-off as possible after you submit the superbill. The ideal company should take over all aspects of the billing process past this point.
Another thing to consider is the software used by the company in question. If you have to learn an incredibly complex piece of software in order to submit your bills, you’re not really saving yourself a lot of time or effort, and may in fact be creating more difficulty for yourself. By the same token, complexity can be a good thing if it offers customization so that you can utilize a custom solution that fits the particulars of your practice, rather than a simply complicated software model that serves no practical purpose.
Hopefully, if you keep these factors in mind you can find a great medical billing service to do business with. It is a lot to keep in mind, there is no doubt about that. But as this vendor is ultimately going to be responsible for the primary revenue stream into your practice, it is worth taking the time and effort to make sure that you’re finding the best possible fit.