Outsource Medical Billing - How to Select a Provider to Increase Claims Collection at Lower Costs

Healthcare providers are often deprived of their hard-earned income because of rejected claims and inadequate follow-ups. Almost 20% of medical bills go unpaid because insurance companies reject claims based on bureaucratic errors and medical providers give up on the collection. Third party medical coding and billing services have the necessary expertise, personnel and technical tools to ensure higher collection of bills, thereby increasing the revenue of medical providers. Following are some of the details a healthcare providers should know of a medical coding and billing provider before hiring it.

Type of medical billing provider

There are many medical coding and billing services in the market vying for clients. Healthcare provider needs to assess their own needs first, and then look for a service that serves their purpose. Most providers offer only billing services; they collect bills by submitting claims accurately and follow up on the payments. Some providers work only for small businesses, which are usually individual setups that offer specialized medical services. Large practice management companies offer comprehensive medical coding and billing packages that include administrative services for running the medical practice effectively.

Policies of the outsourced service providers

A professional medical billing provider follows business practices that ensure high quality of services. Healthcare providers should check the processes followed to ensure effectiveness of the service:

Persistent follow-up of bills

The service provider must follow up on payments aggressively and persistently. Insurance carriers are very fussy and reject or deny claims on administrative technicalities. The provider needs to ensure forms are filled in correctly so that insurance carriers do not get an opportunity to reject them, monitor government programs to ensure accurate payments and pursue all collections with tenacity.

Compliance with regulations

The Health Insurance Portability and Accountability Act (HIPAA) mandates the privacy, security and protection of patient data. Medical coding providers are also privy to confidential patient information, and should comply with HIPAA regulations.

Timely submission of claims

Medical billing providers should be well versed with the process, types of forms and the deadlines for each type of form. Claims must be filed within specified timelines or the insurance company will reject them.

Cost of service

Medical coding and billing service providers charge a flat fee for their services or a percentage of the claim they collect for the healthcare provider. The healthcare provider should examine which fee structure suits them best, and select a service accordingly.

Specialization

Some services providers have a specialty focus in a particular protocol. They promise better collections than general medical coding and billing providers do.

Communication with healthcare provider

The medical coding and billing provider and the healthcare practitioner should communicate openly and clearly to have an effective relationship.

Skills of the workforce

An efficient provider should have trained staff. Healthcare practitioners need to verify the following about the provider's workforce:

* Are the agents trained in medical insurance coding standards?
* How much experience do the agents have?
* Are the agents updated about changing processes through regular trainings?
* Are the agents familiar with both Windows and UNIX based medical coding and billing systems?
* Does the provider work with employees or contractors? A provider that supports its own staff is preferred.

Technology adopted by the provider

Providers have a better chance of getting results if they are supported by latest technology and tools. Electronic submission of forms is more effective and less error prone than manual submission. Incorrect forms are one of the main reasons claims get rejected by insurance companies.

Billing services can potentially increase the revenue of medical practitioners by almost 30%. An effective provider frees healthcare providers from the burden of administrative tasks and allows them to focus on patient care.