Physician Billing Services | Benefits, Cost, and Solutions

On average, a person will visit their doctor about 4 times a year. The latest report from the Center for Disease Control puts the collective annual number of physicians visits at over 860 million. That is a lot of patients to care for.

Reviewing patient forms and submitting claims with insurance companies for payment is a very time-consuming but necessary part of a healthcare provider’s business.

As a busy healthcare provider and business owner, you have a lot on your plate. So does your staff. That is why the right physician billing service could be just the solution you need.

In this article, we’ll go over what physician billing services can do for you and how to find the right one.

What Does a Physician Billing Service Do?

Enlisting the help of a professional physician billing service means you won’t have to worry about submitting error-free billing claims, following up on those submissions, or even collecting the amounts owed.

The major services offered by professional billing companies include:

• Patient scheduling and reminders
• Enrollment into the billing system
• Insurance verification
• Authorization
• Coding
• Billing
• Reconciliation of accounts
• Accounts receivable collections
• Laboratory services (billing)
• Audit

But what do each of these functions cover?

Patient Scheduling and Reminders

Many professional physician billing services will schedule patient appointments, including reminders and follow-ups for any missed appointments.

Enrollment Into the Billing System

Patient information such as names, addresses, allergies, and insurance information, must be entered into the system so that an invoice or claim can be generated.

The more complete the information provided, the easier it is for the claim to be reviewed and payment made.

Insurance companies also require that healthcare providers collect and report demographics for each patient, which can be done easily through a billing service.

Insurance Verification

The most important part of the billing process is the insurance verification step.

A professional physician billing service will confirm patient eligibility and the amount and type of benefits under their healthcare plan.

Authorization

A reliable billing firm will contact each patient’s insurance company to get confirmation that:

• The patient is covered
• What their coverage includes
• Dates of coverage

Confirmation of coverage reduces the odds of any last-minute cancellations of claims which can cost healthcare providers time and money.

Coding

A reliable billing firm performs all medical coding functions, including coding audits, CPT coding, DRG / ICD-9-CM coding validations, and most other related, standard coding procedures.

With so many updates to codes and procedures, having a professional billing service take care of the coding is a welcome relief for physicians and their staff.

Billing

Professional physician billing services will provide support for all phases of the billing process, which include:

• Collecting monthly bills
• Calculating self-accounting totals
• Handling transfers of funds
• Charge entry
• Cash posting

The right billing service will take care of the tedious task of generating, tracking, and sending invoices.

A professional billing service will also keep up-to-date on taxes and other fees billable for each specific state and type of practice.

Reconciliation of Accounts

Healthcare providers and their staff are all too familiar with the back-and-forth process with insurance companies that reconciliation of accounts can include.

A professional billing service will take care of any issues including resubmission of claims or justification of existing submissions.

Accounts Receivable Collections

The most challenging part of the billing process can often be securing payment. A professional physician billing service will take care of everything. They’ll track:

• All invoices sent
• All denials and requests from insurance carriers
• All payments made

Not only will they keep track of all these things, but they will also follow up until payment is received.

Laboratory Services

Most healthcare providers are familiar with all the additional requirements necessary for laboratory service billing. A professional physician billing service will stay up-to-date on all requirements and make sure they are met to avoid any issues with billing.

Audit

A professional billing service will include regular auditing of their charge and input teams to be sure that entries are accurate, and information is correct.

What Are the Benefits of Hiring a Physician Billing Service?

Timely and accurate submission of medical bills and insurance claims is essential to the efficient performance and outcome of a medical entities’ revenue cycle. It’s also a tedious and time-consuming chunk of paperwork.

Not to mention keeping track and staying current on the latest coding and billing procedures and requirements. The American Medical Association has plans to make over 150 coding updates in 2022!

A reliable, professional physician billing service will give you back the time that you would have spent in front of a computer screen or on the phone.

What Are Revenue Cycle Management Services?

Revenue Cycle Management provides the same billing services as physician billing companies but adds the data analysis capabilities possible with software. A dependable revenue cycle management company will cover everything from pre-registration of patients (before their appointment) to third-party insurance and patient collection services.

Revenue cycle management companies also make it easy to have a report generated for things like:

• Daily cash flow
• Weekly collection stats
• Monthly activity

Reports like these will help busy medical practices keep their finances in good health, just like they do for their patients.

How Much Will Physicians Billing Services Cost Me?

As a responsible business owner, you are probably wondering what kind of dent in your wallet all these services will make. As with most other costs, it depends on the size of your practice and what level of service you choose to employ.

When determining the cost efficiency of physician billing services, remember to include your current billing and administrative costs for an accurate comparison.

Most physician billing service companies offer the following types of fee and payment structures:

• Hourly – This is ideal for smaller offices that spend 4-8 hours on billing each week.

• Flat – For medium-sized practices. The going rate for flat fee service is usually between $4 – $6 for each claim.

• Percentage Based – If you have a larger practice and submit a large volume of claims per week, percentage-based fees will likely be your choice. The billing service is paid on commission, usually between 5% and 10% of the amount collected. If no amount is collected, then the billing service doesn’t get paid.

• Hybrid – Most reliable billing services will allow their clients to choose a combination of any of the above types of fee schedules. This is a convenient option for healthcare providers that experience significant seasonal or periodic changes in patient flow and billing activity.

In addition to monthly fees as described above, all physician billing services will charge an annual administrative fee which ranges from $3,000 to $6,000 per year, depending on the size of your office and volume of billing services.

Some billing services will also charge a set-up fee. The amount will vary depending on how many physicians will be included in the services but will usually be $300 – $1000. This is a one-time fee, not annual.

Hidden Fees

Some of the more questionable billing service companies will try to sneak in charges for things like “customer service” or “clearinghouse fees.” Stay away from those companies. You should only be paying for the services provided, not for anything else.

How Do I Choose the Right Billing Service for My Practice?

Once you determine that a physician billing service is right for you, the next step is to figure out which one of the hundreds of providers is the best one for you.

You want to be sure the company can answer the following questions to your satisfaction:

• How much experience do your billers have?
• How do you assure me of HIPAA compliance?
• What kinds of reports will your billing and coding software provide me?
• Can you provide transparency and convenience?
• How and how much will you adapt to my practice?
• Who can I call for references?
• How does the pricing break down?

Where Do I Go to Find a Reliable Physician Billing Service?

Once you are ready to start interviewing potential physician billing services, we can provide you with quotes from reputable, dependable companies. Click here to answer a few questions about the kind of service you are looking for and we will send you contact information for the companies that best match your needs.

Make Outsourcing Your Resource

Physician billing is a complex process that can be overwhelming and time-consuming. Get back to doing what you do best, caring for your patients. Let a physician billing service take care of the hassles and headaches that often come with medical billing.