Finally, some good news from the healthcare industry. Providers and clinics have
found an ally in the effort to collect revenue and reimbursements from insurance
carriers. Third-party medical billing services offer the expertise and resources
to follow up on receivables.
Not all medical
billing services are alike, however. It takes careful research
to find a trusted partner capable of taking over revenue collection, arguably
the most important function of any business. Industry experts offer the following
four criteria for selecting a medical billing service:
1. Business Services
Aggressive follow-up. The number one positive attribute in a
billing service is an active and aggressive follow-up approach. Insurance carriers
can be reticent
to reimburse claims, and may attempt to deny them on administrative technicalities.
Tenacity is key. One industry analyst observes: Your service should
not be passive, but rather fight to get you a better return, monitor government
programs to ensure correct payment, and keep up with all your billing contracts.
Confidentiality. Privacy has emerged as a central issue in the wake of HIPAA,
the 1996 federal act protecting the security of health data. Since medical
billing services handle sensitive patient information, its important to ensure
that this third party complies with security regulations.
Not all service providers are equipped to provide the full range of services;
performing a needs assessment will help narrow the field of candidates. Medical
billing services range from single-employee home businesses to large practice
management companies. Each offers advantages for a certain type of business.
The smallest shops offer personalized attention useful for clients practicing
in a particular niche. Practice management companies offer comprehensive
back-office services to relieve the administrative burden of running a medical
practice. Between these two extremes lie the majority of billing
which focus on accurate claims submission and aggressive follow-up to boost
2. Business Practices
Next, experts advise doctors to examine the business practices of different
service providers. Qualities to consider include:
Timeliness. Timely submission of claims is imperative in a billing system littered
with time limits for filing claims. A medical services provider should know
and observe the particular deadlines for different forms.
Fee structure. The cost of the service will vary depending
on whether the provider charges a percentage of the collections or a flat fee
for service. Evaluate
which of the fee structures suits your business.
Specialty focus. A specialty focus indicates familiarity with a specific billing
protocol, and can lead to better collection results.
Accessibility. Communication between service provider and client is critical
for an effective partnership.
3. Human Resources
Understand both ASP and Unix-based medical billing systems
Are familiar with the latest medical insurance coding standards
Have extensive experience in the field
A professional, trained staff is critical to ensuring the best return. Make
sure that the billing
service provider employs agents who:
Before hiring a billing service, find out whether the business invests in
regular continuing education for its staff. It is also advisable to find a
service that supports its own staff rather than hiring subcontractors.
4. Technological Resources
Finally, access to advanced medical
billing technology can have a significant
impact on the billing services ability to get results. Electronic submissions
reduce the kind of administrative errors that account for most of the claims
rejected by insurance companies. Services that support Palm and PDA medical
billing introduce another level of efficiency into the billing process.
services represent an important partnership capable of increasing
a clinics revenue by thirty percent or more. It pays to find the partner capable
of realizing the full financial value of your medical services.
American Medical Billing Association
Medical Transcription Daily
Preferred Health Resources
Using Medical billing Companies
Premier Billing Network