Medical Billing Companies

Medical Billing Companies Buyers Guide

Last updated: October 03, 2023

Your Complete Buyers Guide When Sourcing a Medical Billing Service

You can only do so much with the time on your hands, right? When you need to focus on your work as a health provider, you know you shouldn’t be limited by the draining tasks of administration. And the solution isn’t always to hire more staff. Outsourcing to medical billing companies makes sense for many reasons, but it’s always a challenge to find the best one for you. 

We can make it easier for you. Use these guidelines to vet the ones you consider and you’ll quickly identify the best option. 

Before You Hire a Medical Billing Service

First of all, it’s not a one size fits all industry. You need a medical billing service that aligns with your specialty as well as the size of your practice. When you sit down with them to discuss, these questions help you gauge their worth.

let’s explore some of the options out there for you. You can choose either of the following to bill on your behalf.

Local company

If it’s a local company, you will have the benefit of on-site support. It’s always nice knowing that if things are not working out; you can actually walk up to their office and push them into action. That’s one of the reasons why many physicians have signed contracts with their local vendors. However, how do you find out if things are not going well for your practice? 

With local vendors, many practices are unable to monitor the performance of their billing company as there is no reporting mechanism in place through which practices can look at the aging of their claims. There is no real time financial aging summary, ability to view pending patient responsibility to name a few. Leaving that aside, these practices must still resort to calling insurances to verify insurance eligibility rather than relying on their billing software to do this task for them. Thus, not only do you have a very basic billing functionality but you are literally dependent on these vendors without any way of analyzing how they are performing. Thus, all you get with a local vendor is a face but no quality. Moreover, this option is generally more expensive than the other two.

With offshore billing companies, your problems are two folds. 

1. Abominable support – the accents, lack of understanding the US insurance system, keeping up to date with payer payment changes, the misfortune of being transferred from one support representative to another rather than having your own billing account manager 
2. Privacy Concerns - Are you willing to risk sharing your patient’s financials across shores in this environment of ever-increasing focus on protection of patient health information and the penalties associated with it? I think not. 

The positives though, these are less costly alternatives. Many of these companies charge you per claim rather than the standard percentage of collections model used across the industry.

Your own EHR vendor (provided they offer medical billing services as well)

The third option is the one that I personally prefer. Outsource medical billing to your Electronic Health Record (EHR) vendor. You will have the obvious advantage of dealing with a single vendor, saving you the hassle of following up or monitoring different vendors to ensure that they are delivering on their promises. Moreover, most vendors with medical billing service will offer you their best EHR Software and Practice Management System (Medical Billing software) for free, which will allow you to have some control/ insight into how your third party biller is performing. Be cautious however; don’t get stuck into the worst of both worlds. 

Questions to Ask

How Exactly Do You Work?

Don’t assume a new medical billing service will work the same as one you’ve used before. These businesses differ in what they offer and their processes.

Submitting to Collecting Agencies

You’ll be using this service to hopefully improve your bottom line. Your forecasts will be based on the billing company’s actions, so you must understand their timelines. Ask how long they take before submitting unpaid accounts to collection agencies so you can plan accordingly. 

Payment Terms

You also need to enquire whether payment is done based on your total revenue. This won’t make sense if the billing company doesn’t affect all your revenue streams, such as income raised by your staff. Rather pick one where payment is based on the company’s collected amount. 

What Services Are Included in the Contract?

First of all, you must know how long the minimum contract period is. You must be free to reassess the situation at some stage and one year is a reasonable period. If you’re required to sign a longer binding contract, it’s often a sign that other aspects of their service are questionable too.

Taking care of medical billing requires a range of actions, of which a medical billing company may perform all or only some. Ideally you can pick a combination of services you want and be charged accordingly. 

Make sure you know what you’re paying for and determine if it will be worth the expense. Don’t pay for services you don’t really need.

Billing Process

You can decide which of these you want handled, or whether your staff will still perform them:

• Coding your accounts according to the ICD-10 system
• Providing you with documents sent by patients, such as electronic remittance advice papers
• Resubmitting denied or faulty claims instead of referring them back to your staff 

Billing and Claims in BlueEHR

Engaging With Patients

A large part of these companies’ responsibilities relates to claiming from insurance entities, but you also need interaction with patients. A billing company can help you engage with your patients to enhance their experience of your practice. However, apart from sending patients their bills, not all of these services are a given:

• Talking to patients via telephone regarding outstanding accounts.
• Using a patient portal which even provides payment options.
• Handling patient enquiries regarding their accounts on your behalf, which is vital to help them understand when and why certain expenses aren’t covered by insurance.

These features add great value for money to the services you receive. Positive patient experiences may lead to referrals, which can have long term effects on your practice. However, your billing company may ask much higher fees to perform these specialized services.

Are You Qualified for the Task?

The ICD-10 system with its more than 70 000 codes transformed how health claims are done. You need a company whose employees understand this system and they must be qualified to code your documents.

What are the Technical Implications?

In today’s modern, tech driven world you must avail yourself of the company’s approach to technical features. 

Servers

Whose servers are used and where will they be kept? Cloud based servers are ideal because they’re often more secure. If servers are kept on your premises you need to formulate a back up system so you can continue working in the even of damage or destruction. If you use the company’s servers, that responsibility will lie with them, but make sure it’s stated in the contract.

Data Ownership

These servers will contain your patient data. Who owns this and what happens with it if you switch service providers? A vindictive billing company may refuse access to the data if you terminate your contract, if ownership isn’t clearly stated from the start.

Will You Help Me Build My Practice?

An objective opinion is valuable in any business. Therefore, ideally you don’t simply want a service provider, but a partner in terms of helping you improve the running of your practice. This is possible if your medical billing company submits reports and even analyzes data to help you make better decisions. 

To enhance this process you would preferably also want free access to details of the revenue cycle. 

After You Hired a Medical Billing Service

Your responsibilities don’t stop the day you’ve employed the most impressive company. Billing still requires constant attention if you want continual success. Yes, this service provider may take many tasks off your hands, but you need to stay in charge of the situation. 

You have the right to rate the billing company’s performance and make decisions accordingly. This is why you should look for an entity that offers acceptable, relatively short, contract timelines. A year into your contract you can gauge whether they live up to expectations:

• The revenue you expected
• Quality reporting
• Dealing with issues rather than expecting you to handle complicated or failed claims

If the one you picked hampers your functioning, doesn’t alleviate work strain or doesn’t improve your bottom line, start again at the first step mentioned above.

Last tip: There are many medical billing companies out there. It’s worth taking your time to search for the right one. When you pick the first one that comes along you may waste money, rather than increasing your revenue. And remember: This entity should make your life easier, not more difficult. The choice is yours—pick wisely.