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Friday, March 29, 2024

What Does A Medical Billing Company Do?

Medical billing companies are responsible for interpreting and posting the EOB (Explanation of Benefits) received from insurers. When patients have questions, medical billing specialists are often the most relevant people that are capable to answer them. 

 

Medical billing:

Medical billing is a procedure for translating medical procedures into standard codes. Medical billing professionals prepare medical claims against medical codes and ensure reimbursement. In basic terms, medical billing is all about making sure the doctor or healthcare practitioner gets paid for their services. 

 

It is a complicated procedure as it involves complex procedures of payment collection. Payment collection usually involves a fairly complicated sequence of events due to partial involvement of both patients and insurance companies. Therefore, medical billing specialists have to encounter complicated detailed procedures to make a massive impact to your private practice.  

 

Medical billing companies provide essential services for the financial administration of hEalthcare business. They proceed following practices for the healthcare industry;

 

 

  • Manage data storage:

 

Medical billing companies usually transact information and patient’s data from the physicians. They have smart solutions to store and configure huge data inventory. Usually, medical billing companies are HIPAA compliant and they implement essential privacy policies to ensure data security.

 

Medical billing companies stay committed to keeping your Protected Health Information (PHI) safe at all times. It is a very big red flag if this isn’t a priority for your current billing procedures. The healthcare offices should partner with such a medical billing company who promise to deliver a high level of security when it comes to your data. 

 

Medical billing companies typically manage the following data;  

 

  • Patient information.
  • Physician information.
  • Insurance information.
  • Payment information.
  • Medical Billing Codes.
  • ICD Codes.
  • CPT Codes.
  • CPT Modifiers.

 

Medical billing and coding specialists encapsulate this information in standard procedural and diagnostic codes. Several different patients visit the physician’s office daily. Medical codes address information of each visit of a patient to the physician’s office. Medical billing specialist often  

 

  A certain percentage of patient visits result in the use of similar or commonly used codes depending on the type of medical practice. Doctors will often enter these codes manually in lieu of using a coder by simply circling them on a patient interaction form.

 

  1. Prevent claim denials:

Medical billing companies Communicate between the related parties (patients, physicians, insurance companies, and government agencies).

When claims are denied, come back unpaid, need to be adjusted, re-submitted, and/or clarified, medical billing specialists are typically the ones responsible for doing the necessary research, correcting any mistakes, and preparing claims appeals as necessary.    

 

  1. Resubmitting or adjusting claims with mistakes and appealing denied claims.

Good medical billing companies will get the information correct the first time. This keeps your private practice from getting tied up in costly back-and-forth with insurance companies in a vain attempt to get paid. Ask your medical billing company about their claims denial rate or the per cent of claims that have to be resubmitted.

 

  1. Collecting payment from insurers and patients and posting any further bills to patients.

for interpreting and posting the EOB (Explanation of Benefits) received from insurers. When patients have questions, medical billing specialists are often the most capable people to answer them.

 

From the private practice point of view, efficient insurance and patient collections is extremely important to the financial health of your business. Revenue cycle management is all about understanding the time-relationship between your patient’s visit and final payment for it. Oftentimes, private practices have nebulous data and insufficient knowledge about where their current revenue cycle stands and how to make improvements. Decreasing the time between treatment and final payment and increasing the percentage of payment actually received can make an extremely impactful difference for the business side of your private practice.

 

Whether you already have a medical billing company taking care of your revenue cycle management, or you are in search of one to help you improve your revenue, there are many things to consider. Partnering with a billing service can often be a long term agreement that will have a lasting impact on the financial health of your practice. Here we’ll cover the 5 most important things your medical billing company (if you choose to outsource) should be doing for your practice on a regular basis to help you accelerate your revenue cycle.

 

First and foremost; you need to make sure the company you have partnered with for billing services has experience in medical coding, billing, and reimbursement strategies for your speciality and your top payers.

 

While experience is a key component to a successful billing partnership, it isn’t everything. There are other factors that come into play when determining how successful your practice will be with a billing service. Here are 5 things worth mentioning that your current medical billing company should be doing. Or if you’re in talks with billing companies, these 5 things are worth asking about to the service companies you’re considering.

 

Your medical billing company should be committed to keeping your Protected Health Information (PHI) safe at all times. It is a very big red flag if this isn’t a priority for your current billing company or those that you are considering partnering with can’t promise to deliver a high level of security when it comes to your data. 

 

In addition to knowing that your medical billing company will ensure the safety of your PHI, it’s equally as important to know how they are doing this. Talking to your medical billing company about how they are storing system passwords, the details of their processes for destroying PHI and email encryption policies will help you to understand how securely your data is being handled.

 

  1. Provide Easy Access to Your Claims Data

Your medical billing company should never restrict you from your own data. If you find yourself unable to run reports to measure the effectiveness of your billing service then chances are your practice is losing revenue due to poor performance.

 

Some billing services have a system set up that restricts the availability of data because they use a separate system for billing management instead of the practice’s EHR software. While this isn’t always a red flag that things have gone south, it typically is an indicator that performance is not where it should be. The worst part? Your practice has no idea of the status of your claims and revenue cycle because you are unable to access the system where that data lives.

 

This can create a huge problem for your practice in terms of money and lead to more problems when you choose to switch to another service. Not having access to old claims, should you decide to switch to another billing service, means that the new service can’t just pick up where the old billing company left off and work that old AR.

 

Your billing service should partner with you to assist you in managing your revenue cycle more efficiently and it should be in a way that benefits your practice and their overall operations. By performing all of the billing functions off of your practice’s existing EHR software, your practice can maintain the visibility on the revenue side that you would have should the billing be carried out in the house. 

 

  1. Deliver Detailed and Useful Month End Reports

Measuring and analyzing your patient and billing data on a monthly basis is vital to the success of your business. This data tells you which areas of your practice are performing well and which areas may need some work either on your end or by your billing services team. By reviewing past performance data and patterns, you can set realistic expectations and develop effective ways to meet them.

 

If you aren’t receiving monthly reports and comprehensive analysis of the data provided, you should be. Or, better yet, you should find a medical billing company that allows you to run and access your own reports whenever you want. This way you know the data is accurate, you can calculate your metrics and compare them against benchmarks on a regular basis, and you can determine if your billing service is as effective as they promised they would be.

 

  1. Constantly Improve Technology and Services

A good medical billing company will provide the minimum services required. A great medical billing company will constantly be improving their use of technology and upgrading the services they provide to help you solve the ever-emerging challenges of your industry.

 

Some examples of these services might include an online patient payment portal to help your practice overcome the high number of high deductible health plans or a self-service knowledge hub to help your practice find answers to common questions on the go.

 

  1. Ongoing Training Opportunities

Don’t overlook the training that your billing service will provide you with. Your medical billing company should always keep your practice informed and educated about new services and codes your practice can use, as well as providing training resources to your staff regarding how to improve operational efficiency.

 

Your billing company should be performing a number of training sessions during the initial implementation process but it is also beneficial to have ongoing training available to your staff on things like increasing front desk collection strategies, documentation and coding, eligibility best practices, etc.

 

If your billing service doesn’t have certified professional coders in place to help providers/physicians improve documentation processes I would consider evaluating other options or hiring a CPC in house. Having a Certified Coder will ultimately improve compliance performance and reduce instances of denials which is a big concern considering the recent end of the ICD-10 grace period.

 

Choosing the right medical billing company Like Medcaremso for your practise should involve thoroughly researching your options based on your specific needs and challenges. The above services and features are just some of the things we believe practices should expect from a medical billing company. If you’re interested in learning more about the services we offer please click here to contact us today.