Medical Billing Services
Outsource your practice's difficult and time-consuming billing tasks. Receive pricing and information from up to three billing service providers.
Understanding Medical Billing
Whenever there is a medical diagnosis, medical procedure, or treatment is given, a medical code is assigned to the service. A medical biller translates the code into a dollar amount or numeric value. This dollar amount is also called a medical claim. This claim is submitted to the insurance company of the patient. An Insurance company then denies or accepts the claim and will send this back to the medical biller.
The job of the medical biller is similar to that of a lawyer. The medical biller will represent the client which is the medical practice. They work to seek the maximum amount paid for the services the client is supplied. A medical biller has to stay in constant communication with the insurance company and the patient to ensure that the client gets paid. A medical biller is paid a fee based upon a percentage of the revenue.
A medical biller takes on the following tasks in most cases:
- They bill for collections
- They work with denied and unpaid claim research
- They do insurance appeal processing
- They work with patient inquiries and General Insurance
- They communicate with insurance carriers to understand their policies
- They fix accounts receivable issues
- They conduct management
Outsourcing vs. In-House
Medical practices often asked if they should keep their medical billing in the house or do some sort of outsourcing. Outsourcing can save money and time but it isn't always the case. Here are the pros and cons that you need to understand both of these options.
In House Pros
- You have control of operational billing
- Your security risk is lower
- There are personal interactions with a patient to discuss any medical billing issues
- There is a low cost if a high number of claims are submitted
In House Cons
- It’s expensive to pay for the salary, training, and benefits of employees
- There is limited support if an employee gets sick you will have backlogs
- You have to follow up on denied claims which can be hard
- There is limited expertise and employs need to stay current on policies that always change
- You may not be getting the best rate as there is no way of knowing
Outsourcing
If you decide to outsource medical billing, then you should understand the type of provider that you need. There are many services that provide medical billing, and they offer different services. Here are some of the things you should keep in mind.
Outsourcing Pros
- You save money if you’re a transitioning or new business
- You will save time as internal staff can help patients more
- The practice has full access to reports for more accountability
- It's easier to scale as you do not need to rely on hiring additional internal staff to do so
- Less concern over the reliability of your billing accuracy as you're dealing with specialists versus multi-role in-house staff.
Outsourcing Cons
- It costs more if the fees are higher than what it takes to hire an employee that works in-house
- When the management has hands-off of the operational finances, there is more risk
- Within a contract, there can be hidden fees. You should watch for management fees and start-up fees
Specialty vs. General Practice
If you're a general practitioner, you'll probably want to use a medical biller provider that handles general practice claims. If the job is more of a specialist job, then you may want a medical biller that has experience with the specialty that you're in. The insurance industry and healthcare are complex. One company can't be an expert in every area of Medicine. A specialty has tricks of the trade, so you need to have someone that understands everything about your profession.
One Shop to Do the Work
Many services that provide medical billing are offering all-in-one services. This combines information technology management, consulting, and medical billing. This means that you don't have to sire a separate company to manage your IT issues or software. These companies will cost more but it gives you a streamlined approach and it might be the best fit for your practice. You should make a note of the experience and the background of a company that offers all of these services. You will want a company that has experience in all areas.
Offshore vs. Local
You will find both local providers as well as those that are offshore. If you are shopping based on the price, the offshore billing company will be less expensive. There are many medical billers offshore that are reputable. You still want to do a lot of research before you sign any type of contract. Some companies that work offshore don't have the experience to navigate the insurance appeal process in the United States or understand the healthcare system fully. A lot of the representatives for these companies don't speak English.
When looking for someone locally, you may have to spend more. did manage to this is that they are available all of the time, and the service level can be quite high. How much you spend will all depend upon your practice and your priorities.
The Cost
A medical billing company will make their revenue by charging a percentage of the net revenue of the practice. They may also charge on net claims or net collections. These companies charge differently so it's difficult for you to make a price comparison. In general terms, they will charge an average fee that is around 4% to 10%
How You Pay
- The higher that the claims are the lower the percentage that you're going to pay
- If you see more patients, your rate will be lower
- The lower your cost per each claim, the more you're going to pay. You may pay a flat fee
Fee Structure
- Collected Amount - A medical billing service will receive a percentage of claims that the medical practice has collected. This won't include co-pays, deductibles, or other payments made in office. Many practices will use this option because it correlates directly to the profit they have earned
- Total of the Claims Submitted - Fees are paid, which are based on a percentage of the girl's claims submitted to insurance providers or other debtors. the downside to this is the medical biller provider doesn't have an incentive the follow up on the submitted claims aggressively
- Total of the Collections Processed - A collection fee is based on a percentage of the net collections. This won't include co-pays, deductibles, claims, or other payments made in office. Many medical practices choose this because it gives a greater incentive for billing service to follow up on any claims
- Fixed-Rate - This is a charge per claim. It can range from 1 to $2 per each general practice claim. For specialty claims, it may be around $4 to $7. This type of fee structure will save the practice money upfront. The problem is it doesn't offer an incentive for the medical biller to follow up on any claims
- Hybrid - This is a charge that is based upon a percentage of the claims which are submitted to specific accounts or insurance providers. Other claims will be charged at a fixed rate. Many medical practices in the states use this as a popular choice. A lot of medical providers are considering percentage billing to be an illegal practice.
You need to crunch the numbers. If the fees are not offset by your net collections, it's not going to be worth your money.
Choosing Your Medical Billing Provider
Once you're ready to start shopping for a provider for medical billing, you have questions you need to ask which are as follows:
- How long have you been involved in the medical billing industry?
- Do you have a specialty?
- How long have you been in practice?
- What sort of training does your staff receive?
- Do you have specific software that you use? Are all of your plans required to use the software?
- What will I be receiving with your service?
- What is your processing rate? What is the average collection rate?
- What hours are you available? How can we contact you if we have a question?
- Is there a limit on the number of times that you resubmit a denied claim?
- Do you allow your client access to complete reports?
- Does your company adhere to HIPPA requirements?
- What is the time frame for the average claim submission?