Medical
practices are required to undergo huge changes from time to time to keep up
with the new regulations and technology introduced by CMS in healthcare
industry. Take the upcoming ICD-10 implementation, for example. Physicians have already begun preparing their
staff (both clinical personnel and billers) for the regulations introduced by CMS
for the new coding system.
The
challenge
One
of these regulations requires practices to upgrade their medical billing system
completely. As it sounds, upgrading the entire medical billing system of a
practice is a very expensive and lengthy task, which is why many small and
medium practices are considering outsourcing their billing to medical billing
companies.
The risks
Outsourcing
medical billing to a third party is indeed a huge risk. However, this option is
feasible for practices that lack the resources, space, people or finances required
to keep Medical Billing
in-house.
Cheaper
options: Despite
the need, physicians must be very careful in choosing a billing vendor for
their practice. They should avoid medical billing companies that cost much
lower than the industry average. Yes, discard the “free medical billing” and
“1% of your collections”. Such deals are backed by numerous hidden costs,
substandard service, and huge cash flow disruptions for the practice that opts
to join them.
References: Some
vendors avoid giving any references other than the ones on their printed list.
Limited
services: Others don’t provide physicians with daily
reports and access to their software to check patient accounts.
Such
billing companies may not provide good results or improve practice workflow and
can drag medical practices to bankruptcy.
The
evaluation criteria
Alternatively, providers must carefully
evaluate Medical Billing Companies on the following criterion:
1.
Level of service
All medical billing companies
offer basic billing services like claim generation and submission, payment
processing and patient invoicing. Providers should thus look for companies that
provide additional services like tracking of submitted claims, pursing of
denied claims, regular follow-ups, and timely reporting. The medical billing
companies should also comply with any recent or upcoming CMS regulations or
health IT changes like ICD-10.
2.
Industry experience:
In addition to relevant healthcare
industry experience, the medical billing vendor must also be familiar with the
specific medical specialty of the physician or medical practice. Choosing a
vendor that is already familiar with the practice specialty will be a plus
point for the physicians as this means the new partnership will get along
smoothly and there will be no decline in practice revenue.
3.
Use of technology
The medical billing service provider
must also make use of technology in such a way that it reduces the gap between
the provider and biller. For example, the billing company must have flexible
medical billing software that can be integrated with the provider’s EHR.
4.
Pricing options
Medical billing companies may
charge medical practices a percentage of its collections or a flat fee. Some
companies have a hybrid pricing option, which includes both flat fee and
percentage rates. There are other billing companies that offer all three
pricing options to medical practices. Physicians must look for a reasonable
pricing option that does not exceed the industry rate or is very cheap. The
pricing option can be compared to the kind of services the company offers or how
other providers have reviewed the company.
5.
Capacity to take on new clients
Lastly, providers must observe
the past the Medical Billing Services Reviews and determine
whether it has the capacity to take on a new client or not. Sometimes a medical
billing service takes in too many clients that its resources fall short to
handle the outstanding bills, or in following up on the numerous claims sent to
different insurance companies. This can affect the performance of the company
as well as the revenue of all the clients.
The criteria mentioned above can
help medical practices in finding a suitable vendor to handle its outsourced
medical billing. Moreover, physicians can further narrow down their lists of
billing vendors by observing their ratings and reviews on top rating websites
like Top Ten Reviews, Software Advice, Technology Advice and Capterra. These
sites also offer consultancy services for practices that are still unable to
find a suitable billing vendor.
