Medical Billing Services: Choose the Type That’s Right for Your Practice

Medical billing service providers come in many different shapes and sizes. At one end of the spectrum are the large Practice Management Firms, with an extensive but sometimes rigid and expensive support network. At the other extreme are small home-based businesses. With more and more programs offered through local colleges, mail order, and online, home-based businesses are popping up everywhere. Somewhere in the middle of these two extremes is what we will call Medical Billing Professional Services. When considering your options, it’s important to understand what each type of medical billing service provider has to offer and which one is best for you. This article looks at these common types of medical billing service providers and some of the services they offer.

Home Medical Billing Companies they vary significantly from one to another in experience, capacity and services offered. Many are small start-ups with just one or two employees. Some offer extensive experience from previous employment in a medical office, others may have only one or two clients. While these service providers can offer the highest levels of customization, a small home-based business can sometimes run out of management skills and business acumen to be there for the long haul. And what happens to the cash flow practice when the lone biller decides to take a vacation? Most provide basic medical billing services (discussed below) and many have other personal experience in providing ancillary services.

Practice Management Companies They are usually larger companies that may have 100 or more employees. Most true practice management companies take a holistic approach to supporting your practice, looking to handle all facets of running the business, including medical billing, marketing, staffing, and even patient scheduling. . While some providers may be excited about the opportunity to have a practice management firm take all the “hassle” out of them, others find it stifling to have someone else running their business. While their offering may be comprehensive, providers interested in working with a practice management company should carefully read service agreements and contracts to ensure they know exactly how their practices will be “run.”

Medical Billing Professional Services fall between the extremes of home medical billing businesses and practice management firms, taking advantage of the strengths of both and eliminating the weaknesses. With a few dozen employees, Professional Medical Billing Services can offer more flexibility than a practice management company, but more structure than in-home service. Clients often find that medical billing services have a sustained support network to eliminate interruptions in cash flow from vacations or unexpected absences, while offering personalized services tailored to their needs.

When considering each type of medical billing company, it’s also important to think about what services you need, what services you can handle in-house, and what expectations you have of your medical billing professional. Each of the types mentioned above should be able to offer the following standard services; although service delivery, flexibility and customization can vary widely.

Standard Medical Billing Services

The standard services offered by medical billing companies are generally similar across the range of companies mentioned above. There will be variations in the level at which those services are provided. Again, experience and size play a key role in defining where the variances might be. Regardless, the following list identifies the most basic services provided by any well-organized medical billing company.

Generation and presentation of claims Claim generation includes entry of patient demographics, insurance, and encounter information into medical billing software. Claims filing is the process of submitting that data to the carrier, either electronically through a clearinghouse or by paper submission through the mail. With electronic medical billing, services must apply one or more “scrubbers” to claims (and manual quality checks to paper claims). Debuggers are diagnostic quality assurance checks and procedure codes for errors or discrepancies, typically built into premium medical billing software programs.

carrier tracking Carrier tracking is an integral part of the medical billing industry, possibly the most important aspect. The quality of a medical billing service is often defined by the level of follow up they apply to claims and will have a huge effect on reimbursements. Through tracking, medical billing companies can isolate those claims that may be unpaid or partially paid, and work with the provider and carrier to make sure edits and resubmission (if necessary) are clean.

Secondary, tertiary and workers’ compensation claims These special claims generally require special consideration and handling, as they often involve additional documentation. Service providers can sometimes get bogged down in the details required for these unique claims if they are inexperienced and unprepared.

Reporting and Analysis Practice Reports can be generated through almost any medical billing software, but how often and in what depth will your medical billing service provide these reports? The reports provide critical information on avenues for practice improvement, such as growth directions, cost savings, and ways to increase profitability. The importance of reporting to monitor the health of the practice cannot be overstated. Reports must be provided at least monthly, and experienced medical billing service providers must be able to make recommendations on how the practice can improve profitability.

Billing and patient support Patient billing is a very detail-oriented process, but if done correctly, it can significantly improve practice revenue. However, settling accounts, printing statements, stuffing envelopes, and applying postage can be time consuming. And once patient statements are submitted, someone will inevitably have a question about their bill. A good medical billing company has the infrastructure to support patient inquiries with a customer-oriented approach that shows they understand that their conduct is a reflection of their practice.

Other services

Since most medical billing services have a lot of experience working together with a medical office, other services may be offered. Some lateral practice services may include the following.

accreditation Accreditation may be of particular importance for new practices. This process of “signing up” with carriers for the first time can be tedious and overwhelming, especially when you’re just starting out. Accreditation services are also an asset to established practices as another way to grow new business. Many medical billing companies bring experience of working with carriers to help make your accreditation easy.

medical coding A natural extension of the medical billing service is medical coding. Coding is really the first step in the billing process, preparing diagnostic and procedural information for input into medical billing software.

Transcription With extensive experience in the field of medical practice support, it’s only natural that many established medical billing companies expand their offerings to include transcription services. Familiarity with HIPAA requirements and in-depth knowledge of the insurance industry support this natural addition to practice support services.

HIPAA compliance The detailed requirements of HIPAA are not limited to health care practices, they extend to anyone who handles patient information. Medical billing services well-versed in the responsibilities outlined by HIPAA often develop programs to help their clients stay compliant.

Resume

Association with the right medical billing service is vital to the success of your practice. As with finding a good accountant or attorney to support your practice needs, it’s imperative that you feel comfortable with your medical billing service provider; they are the key to your income stream. There are many different types of medical billing service providers to choose from, each with their own advantages and disadvantages. The key is deciding what type of medical billing service provider you are most comfortable with and developing an open working relationship that will help you prosper.