Medical Billing Services

Medical billing services can increase your revenue by reducing the number of denied and unpaid claims and free up your time and resources for your patients. Medical billing services also offer optional services such as handling calls from patients inquiring about their bills.

Medical Billing Services Overview - Medical billing services provide a valuable service for medical practices by eliminating the collections and claims process for the organization. These service companies submit claims to insurance companies, Medicare, and sometimes to patients. Some billing companies work to collect outstanding delinquent claims while others do not. Virtually all medical billing services submit claims, which substantially reduces the amount of time the medical practice waits for payment as electronic claims are typically processed faster than claims submitted on paper.

Claims that are submitted electronically have fewer errors than those submitted on paper because medical billing software is configured to catch errors such as coding or mathematical mistakes.

The efficient medical billing services company will follow up with claims on a regular basis, answer patient billing inquiries, and reduce the amount of claims that are denied by submitting correct claim information in the first place and by consistently following up on claims that may be dragging. Since most medical office personnel do not have the time to devote to chasing after unpaid claims, it is easy to understand why using medical billing services can actually increase the revenue for the medical practice.

Some medical billing services charge a flat rate for their services and others charge based on the amount collected. Since the method by which the company charges for its services can have quite an impact on your bottom line, this is something worth considering before you are obligated.

Benefits - There are numerous benefits to using medical billing services to manage the claims process for the medical practice. By utilizing the services of a medical billing company, the medical staff is free to concentrate on the health and well-being of the patients without the daily interruptions associated with medical bills and practices.

Medical billing services streamline the billing and collection process and are experienced working with multiple carriers and providers. Many of these companies have state-of-the-art equipment and security systems in place to ensure patient data is kept confidential and claims are processed in a timely and secure manner.

Using the services of a medical billing company reduces overhead and the problems associated with the turnover and hiring of qualified personnel. Your collection processes won't suffer from employee-related illness or vacation time being taken when these services are outsourced. Another important benefit to consider when contemplating the use of medical billing services is that no one in your practice will be aware of the amount of revenue being generated so that your privacy is not compromised.

Medical billing services can actually increase your revenue by reducing the number of claims that are denied and by closely following up on the overall claims process. Additionally, medical billing services use software that includes a system of checks and balances to eliminate errors before claims are submitted.

Medical billing software - Medical billing software can streamline not only the billing process but facilitates the integration of the entire patient management system. Your office can easily schedule patient appointments and access patient data using the same program integrated within the financial ledger and billing software.

By combining both medical billing software with practice management software in one easy to use interface, your employees will only have to learn one program yet will have all pertinent patient data in one easily accessible location.

Medical billing and coding software is an important consideration for your medical practice because the various software packages on the market today cover a wide variety of tasks. It is important to realize what you are purchasing because some medical billing software will work in conjunction with the medical billing services company you have contracted with to do your billing while other medical billing software simply provides a process for your own employees to do the medical billing.
Some medical billing software packages are comprehensive while others allow for optional additions so that you can customize your package. As this software can run in the thousands of dollars, it is wise to purchase only the modules that you specifically need.

Electronic medical billing - Because electronic claims are processed quicker than their snail-mail counterparts, it is to your advantage that your claims are processed electronically whether you engage the services of a medical billing company or process them in house using medical billing software.

Much like filing your taxes online, utilizing electronic medical billing services provides a system of checks and balances that rival the human eye. Submitting paper claims with the wrong code can result in long and arduous payment delays while medical billing and coding through electronic channels is much faster and more reliable.

Claims can be tracked and managed much easier and faster electronically and the reports that can be generated offer instant and invaluable information that can take hours to cull from paper files. For example, managing claims electronically can apprise you of data such as a higher percentage of denials regarding a certain procedure or carrier. The electronic management of claims often has a built-in system for changes regarding forms or procedures that you might otherwise be unaware of until a claim or many claims have been denied.

Electronic medical billing and coding offers you all the flexibility a paper management system offers yet streamlines the entire process, which saves time, money and aggravation. You can set the parameters such as how often to send statements and what to include on those statements. You can also choose to hold off sending a statement to a patient whose claim has been filed but not yet paid, as these statements often prompt a call from the patient inquiring as to the problem.

Choosing a medical billing service - Taking the time to select the right medical billing services company will pay off almost immediately. Not only do you have to ensure they provide all the services you require but there are many other things to take into consideration as well. While literally thousands of medical billing companies have sprung up seemingly overnight, not all of them have the expertise to handle a thriving medical practice.

There are successful home-based medical billing companies and there are large firms that provide this service as well. Ultimately, it is the needs of your practice that will help determine what type of billing company to work with. While a home-based business with one or two employees may be able to provide personalized service, they may not be equipped to handle a large amount of claims, especially when you consider the follow-up process and the inevitable customer inquiries.

If at all possible, you'll want to interview a representative from the billing company in person in order to ascertain the company's qualifications. After all, you're entrusting them with your livelihood so by taking the time at the outset to secure a reputable and successful billing company, you'll avoid massive headaches down the road.

Services offered by medical billing companies - A variety of medical billing services are offered by medical billing companies. If you are considering outsourcing your billing, you'll want to evaluate the services you desire depending on the size and needs of your practice. For example, some billing companies provide customer service to patients who call about their bills. This is an important consideration because by utilizing this service, your patients will be able to speak with the person who submitted the claim and who dealt with the insurance carrier or Medicare, etc.
Most billing companies offer follow-up service to the claims they submit for payment and work diligently to see that those claims are paid. This is an important part of the medical billing process and experienced medical billers are often able to reduce the amount of claims that are denied due to their follow-up practices.

Some medical billing companies will train your staff in order to ensure they are receiving the correct information on a timely basis. This can help streamline the entire billing process and reduce errors. Additionally, with billing matters being handled outside of your office, the front-end employees will be better able to focus on the daily running of the office.

Communication is vital when you outsource your medical billing so that you will understand exactly which services you are purchasing.

Medical billing certification - While there is no federal law that mandates that medical billers hold any certifications, those that do are usually more attractive to those seeking to retain medical billing services. The Certified Medical Reimbursement Specialist (CMRS) certification is earned by passing a comprehensive examination comprised of 16 section tests that cover all aspects of medical billing and coding.

The examination is offered to medical billers through the American Medical Billing Association (AMBA) and covers subjects such as medical coding, insurance and insurance carriers, medical terminology, information technology, compliance and others.

Once you decide to engage a medical billing services company to manage your patient billing, you may want to inquire about certification. It stands to reason that billers who hold this certification would have a more comprehensive understanding of the medical billing and coding policies and procedures. Keeping this certification also requires ongoing education regarding the medical billing and coding practice so it would certainly be prudent to consider those individuals or companies that possess this certification.

While certification is no guarantee of reliable service, it is a good place to start when searching for medical billing services.

Medical Coding - While medical billing and coding are two separate functions, they are closely related. The medical biller should have knowledge of medical coding however most medical coding specialists don't do the billing. Just as you would want your medical billing services specialist to be certified in order to ensure they possess the knowledge this function entails, medical coders can be certified also.

The American Academy of Professional Coders (AAPC) certifies those coders who have met rigorous standards and have passed the medical coding examination. Whether you use an in-house coder or let the medical billing services company do your coding, certification assures a higher standard of work than you could expect from someone who is not certified.

Many medical practices elect to keep the coding work in house when they outsource the medical billing and this is an important consideration because not only can coding mistakes lead to delays and denials in payments but can also spell legal trouble for the physician or practice involved.

Associations - You may want to verify certification of medical billing services or individuals before you hire them or contract for their services. You can contact the following associations for more information or to verify certification. Although medical billing and coding specialists are not mandated by federal law to be certified, you can be assured that the ones who are possess the specialized knowledge and experience necessary to work in this industry.

The American Medical Billing Association certifies medical billing specialists who pass a comprehensive examination and their website lists the names of those certified as a Certified Medical Reimbursement Specialist (CMRS).

The American Academy of Professional Coders certifies medical coding specialists who pass a medical coding examination and who have experience coding. They also offer specialized certifications for those coders whose area of expertise lies in certain medical specialties such as obstetrics and gynecology, general surgery, orthopedics and other areas of specialty. This association also offers the verification of credentials on their website.

Healthcare Billing and Management Association is a trade association for third-party billers with a vast amount of pertinent material on their website. You can verify credentials on their site as well as search for a medical biller in your geographical area, by area of expertise and also through the company at which they are employed.

Medical billing and coding specialists are held to a strict code of ethics and must be well versed in compliance issues as well as all aspects of billing and coding.