Medical Billing Services

By Sylvia Rosen

Outsourcing medical billing is growing in popularity for healthcare facilities, specialty clinics, and doctor's offices who want to save money. Many smaller healthcare offices choose to outsource medical billing to relieve a heavy workload and conserve resources to enable staff to focus on patient care.

A larger healthcare clinic may choose to outsource medical billing to a third-party provider to increase accuracy and reduce the risk of rejected claims. If a clinic experiences a large number of claims that come back rejected due to coding errors, it can waste money and cut down on office productivity.

Outsourced medical billing may also provide a doctor's office with the opportunity to get their money owed faster. Smaller practices that don't have the resources to hire medical billing specialists may take significantly longer to submit insurance claims without the manpower needed to follow up quickly for a prompt payout.

What services are provided by a medical billing company?

Depending upon the firm that is hired, the level and complexity of a medical billing service can vary greatly. Many companies even tailor their billing practices and procedures to the specifics of your specialty. Professional medical billing companies will normally offer the following:

• Claim generation and submission
• Claim scrubbing to reduce the necessity for resubmission
• Insurance carrier follow-up
• Payment posting and processing
• Patient invoicing with continued support
• Collection agency transfer services
• Web-based software that is quick to learn, leveraging the familiar browser-based format
• Customizable reports that provide real-time data on the performance and trends related to your practice

Advanced services available can include:

• Insurance carrier credentialing
• Medical coding specific to your specialty
• Medical transcription
• Insurance eligibility verification
• Appointment scheduling
• Appointment reminders

To walk you step-by-step through the process, most medical billing services will begin by providing support for individual patient registration. Patient insurance information must then be verified with an accurate code review for all medical treatments that have been completed in the facility.

From there, medical claim preparation and submission can be executed, followed by payment adjudication monitoring with insurance follow-up to ensure funding is paid out in a timely manner. For unpaid patient invoices, a patient account may be referred to a collection agency. A patient account is then finalized with payment posting once the billing matter has been resolved.

How to decide on a medical billing provider

Outsourcing medical billing can seem overwhelming at face value, in light of the many complex services that are offered above. When a healthcare facility chooses to put their financial management into the hands of a third-party company, it is important to select a medical billing provider with experience and accurate technology to process each claim thoroughly and expediently.

Regulation compliance is also a key determining factor. The growing integration of mobile technology into every corner of the medical field has made regulatory compliance a growing concern, in particular with regard to privacy and the security of a patient's health data. Make sure the medical billing services you're comparing enforce strict policies in line with the Health Insurance Accountability and Portability Act (HIPAA).

Finally, you can take pricing and service menus into account when making your decision. While it's important to choose a medical billing company that is competitively priced, they must also offer the specific services your office requires to ensure that daily claim processing is expedited for a prompt payout.