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Attributes of the Best Medical Billing Companies

Attributes of the Best Medical Billing Companies

With the increasing complexity of the American healthcare system, medical billing companies become an even larger asset to practices across the nation. There are many companies that claim to offer the best for your practice, but what should you really be looking for? The following are essential components of the best medical billing companies in the business.

Deep Understanding of Medical Practices

The account managers and the leader of a medical billing company should have a strong understanding of the common codes and modifiers for your practice.   The leadership should understand what key performance indicators (KPI) a practice should monitor to identify growth rate of the practice as well as overall revenue performance.   There are many billing companies as well as billers that work for medical practices that only send medical claims through the clearing house while missing the level of follow-up and resubmission needed to exceed benchmarks..  The best billing companies understand that medical billing is about systems, processes, execution and understanding the data related to the practice.  Understanding the data as well as a clear monthly report for the practice leaders to review is an attribute of a top Medical company.

Consistent Execution to Optimize Billing Performance

There is a significant difference between pushing claims through a clearing house versus optimizing the revenue cycle.  To optimize the revenue cycle, the billing team needs to be managed to goals that promote optimal billing.  The process by the medical company needs to be able to identify issues with payers or payment trends.  Additionally, the people of the account need to be dedicated billing team members.   Sometimes larger companies have challenges with staff turnover (good billers moving to other positions or accounts) or inexperienced billers on the account.   The “do it myself’ medical billing approach requires a practice owner to attend training from various sources such as MGMA and AAPC as well as to develop monitoring and management tools for their practice.  A biller needs a leader that has strong knowledge of the revenue cycle.  This takes years to gain the skill and the maintenance of the skill requires consistent reading and education.  The “do it myself’ approach can also cause a loss of focus of a provider or practice owner by taking time away from revenue-generating activities that increase patient volume.

Solid Functionality:

A medical company should be able to perform the following basic tasks that are integral to the revenue process as a whole:

  • Create claims and submit them after scrubbing for errors
  • Follow-ups for accounts that are not paid as well as follow-ups with clients
  • Customer service for patients’ billing questions
  • Post/process payments
  • Manage the transfer services of collection agencies

In addition to these preliminary tasks, more advanced features such as system for the practice to use for patient registration, medical coding, scheduling of patient visits, and checking insurance eligibility are offered by the top medical billing companies.

Relative Reports:

It is important for medical practices to receive information about their practices on a regular basis. The best companies should be able to meet your needs by providing a monthly report that is sent to the practice owner/leader.  This report should provide a summary of the key performance indicators of the practice so the practice leader can quickly review the billed amount, collections and AR for the practice.

Availability of Staff:

Due to the complex nature of the billing process, there are sure to be numerous questions you come up with for your billing company. Therefore,the best of these companies have routine office hours and an answering or voicemail service after hours. Also, they will provide a multitude of ways to contact them with questions and respond in a reasonable amount of time.

Medical Knowledge:

Impressive medical billing companies will be completely up-to-date with the current medical coding as well as have a strong background in implementing the coding in the payment process. The switch from ICD-9 to ICD-10 has created large discrepancies and confusion in the medical world so far. Thus, the most efficient medical billing companies will provide a smooth transition between the two coding systems and be fully trained in both.

Software:

In addition to the aforementioned features, the top medical billing companies will typically provide their own software or have a deep understanding of software systems.  This includes electronic medical record software in order to optimize efficiency for clients. By using the electronic medical record software, users can manage their practice and revenue cycle all in one. The software keeps the process compact and simple. Coding, scheduling, payment processing, and insurance claims all become one click away. Moreover, these softwares are often offered as a free feature when you sign on with the billing company.  Additionally, the company should be developing new enhancements like an online invoice system for online payments

Pricing:

The nation’s top medical billing companies are not necessarily the most expensive but are not the lowest cost.   Anyone can ‘push claims’ through a clearing house but there is much cost in consistent claim follow-up practices and systems implemented by the best medical billing companies..   Consistent execution of processes and systems that optimize revenue to a practice requires work, follow-up and continuous ‘tweaks’ to the revenue cycle. The best companies will list fair prices for their services, but more importantly, they will achieve the ‘best’ outcome for your practice.  Discuss pricing openly to understand the trade offs.

Security:

Medical billing companies should all pass the requirements of HIPAA, OIG, as well as other patient privacy regulations. However, the best of these companies will have increased assurances to protect valuable patient health information.

In summary, there are many medical billers and Medical billing companies that market to practices.   The best medical billing companies have attributes that help their clients optimize the revenue cycle and exceed performance benchmarks.  Retaining a Medical Billing Company that achieves and maintains high performance is an asset to a medical practice.   Are you waking up at night worrying about the management of the revenue cycle for your practice?  If yes, find a medical billing company that achieves consistent high results as described in this article..