Medical billing solutions oversees the money side of healthcare providers by coding medical services using comprehensive codes and submitting claims to the insurance companies for prompt payment. Medical billing services help the entire revenue cycle from patient scheduling and insurance verification, to claim filing and payment posting and denial management. The service enables healthcare providers to be paid both accurately and in full for services rendered.

Why Does Medical Billing Matter?

The primary goal of medical billing is proper payment for the healthcare provider. Medical billing provides intermediary functions between the patient, insurance company, medical facility, and healthcare provider. This is done by converting medical procedures to billing codes for timely payment while limiting errors and protecting the financial viability of practices. Timely and efficient medical billing will impact patient care and limit disputes regarding a bill or payment methods. Healthcare providers do not get paid for their services without proper medical billing practices.

Key Functions of a Medical Billing Service

A good medical billing company does far more than just submit claims to insurance providers. Their role is comprehensive and essential for the smooth financial operation of healthcare practices. Here are the core tasks they expertly handle:

• Insurance Review

Prior to the initiation of any treatment, the billing company will check the patient’s insurance benefits and eligibility. This is important because it will ensure that the patient’s insurance is legitimate and active, so that you are less likely to run into issues with claims being denied or delays in payments for services rendered.

• Proper Coding

The billing company converts medical conditions and procedures into recognized medical codes. Coding is important to get correct, as even a small error could lead to a claim getting denied or being underpaid.

• Claim Submission

Once billing is complete, the billing service will submit the claims to the proper insurance companies. The claims will be reviewed carefully for accuracy and completeness. The goal is to limit the chance of rejection or additional information being requested.

• Payment Posting

When the insurance provider processes the payment, the billing company posts the payment to the patient’s account. If there is any outstanding balance after insurance pays, the billing service takes responsibility for billing the patient promptly.

• Denial Management

When a claim is denied, the billing company does not simply throw in the towel. They look into the reason for the denial, fix any errors, and rapidly re-file the claim for reimbursement.

• Patient Billing and Support

The billing company also takes care of patient billing through clear and detailed statements. They also send patient payment follow-up reminders and provide customer service support to answer any patient questions, but provide transparency and efficiency in the patient billing process that is easy for the patient to understand.

By handling these very important functions, a good billing company allows healthcare providers to focus their time and attention on providing care for their patients and stay financially healthy.

• Outsourcing Medical Billing

The benefits of outsourcing medical billing are plentiful and explain why nearly all healthcare practices offer this service. Here’s a review of what makes outsourcing so effective:

• Reduced Costs

The cost of hiring and maintaining a billing employee is significant. You pay their salary, give them benefits, and potentially provide training and obtain billing software. These costs (salaries, benefits, software) can be avoided by outsourcing and allowing the practice to spend money more efficiently.

• Reduced Errors

Medical billing services have a concentration of knowledge on medical coding and claims processing. They keep abreast of ongoing changes in regulations and payer policies. They are therefore experts in reducing error, lowering the chances for claims to be rejected, and thus speeding up reimbursement.

• Increased Patient Time

When a practice partners with a billing service and is able to shift the billing function to that team, the practice saves additional time because neither the provider nor the staff will incur costs related to billing functions. Instead, providers will spend that time with the patients. The time productivity will lead to better quality of care and higher levels of satisfaction amongst patients.

• Increased Time to Payments

Billing services know how to properly ensure the claims process works in the revenue cycle. They are best able to get claims out of the practice efficiently, and they follow-up on unpaid claims, So there will be steady cash flow and quicker payments to the practice.

• Compliance

Healthcare laws, including HIPAA, are changing constantly, and payer requirements evolve. A billing company will keep a practice compliant, thereby reducing the risk of costly audits, penalties, and litigation.

In summary, medical billing is more efficient, and decreases errors and claim denials, increases revenue and patient time, leads to quicker reimbursement, and keeps the practice compliant with reducing the liability of audits and lawsuits.

Choosing the Right Medical Billing Service

For any practice in healthcare, it is important to pick the best medical billing service for an efficient financial operation of the practice. Not every billing company can provide the level of service and skill set you require. It is helpful to understand what to look for in advance.

1. Experience Related to Your Specialty

Each medical specialty has its own billing dynamics and coding nuances. For instance, you would bill a procedure for a pediatric practice differently than you would a surgical or emergency care practice. Choose a billing company that has demonstrated experience in the same specialty you are in. This will ensure accurate billing and maximize your reimbursements.

2. Honest Pricing

A trustworthy billing company should be upfront and transparent about their fees, regardless if it is a flat fee, a monthly set fee, or percent of your collections. When you know what their fees are you can make a clear decision about your costs.

3. Using Technology

Technology plays a crucial role in effective revenue cycle management. Identify a firm that offers a contemporary cloud-based billing service. These systems allow prospective billing organizations access to billings information in real time, along with increased flexibility of claims and payments tracking and monitoring.

4. Support

It is important to have a service provider that has a dedicated account manager and responsive customer support. It makes easier to resolve issues quickly and to answer questions.

5. Compliance Knowledge

Regulations that govern health care are complex and always changing. It is important that your field source indicates knowledge in HIPAA as it pertains to protecting patient information and the safeguarding of Protected Health Information in their billing process to keep your organization compliant with industry regulations.

While medical billing can be complicated, it does not have to be difficult. A quality billing service can save your practice time and money and improve cash flow. Whether a small practice or a large practice, a billing service can greatly assist with efficient billing, which is critical for future financial stability.

Through outsourcing, providers can lower costs by as much as 80%, with hourly rates starting at $7. Vendors offer billing services tailored to their specialties as well as full end-to-end revenue cycle management. This allows urgent care centers to reduce their administrative burden, so they can spend more time on patient care.