By outsourcing medical billing, providers can reduce the burden of auditing all billing before claim submission and focusing on denials and rejections, so they can provide exceptional care to their patients.
Medical billing is a full-time task for most practices. Depending on the number of providers and the volume of patients seen, multiple staff members may be required in order for the billing function to be appropriately managed. The outsourced medical billing company makes sure the appropriate people are in place in order for their clients to maintain or increase cash flow.
Front-desk staff can direct their focus on verification of insurance coverage and benefits, collecting projected patient balances up front. This reduces the number of statements that need to be generated and the number of patient accounts requiring additional collection efforts. Most outsource medical billing companies will also agree to mail patient statements on behalf of the provider.
It is common practice for outsourced companies to charge a percentage of collections (insurance, patient, or both), as it is to their benefit to reduce the volume of denials and rejections by sharing their recommendations with the provider. They also benefit by utilizing their expertise in proper coding guidelines to maximize reimbursement, providing education and guidance to the provider. Most will also verify that reimbursement rates align with payer contracts, that billing guidelines are followed according to contract, and that reconsiderations and/or appeals are generated when necessary.
Choosing the Right Outsourced Medical Billing Company
Experience with the provider specialty is essential for a positive relationship between the provider and the outsourced medical billing company. The more experience the company has pertaining to the provider specialty, the easier it is for each party to relate to one another during discussions.
A business associate agreement (BAA) should be the first step in initiating the connection between the provider and the outsourced medical billing company. This agreement outlines the privacy responsibilities of the company pertaining to the Health Insurance Portability and Accountability Act (HIPAA). Reputable outsourced companies will offer a BAA upon the initial consultation with the provider.
Whether you’re an established practice or a provider starting a new one, you should understand the medical billing services being offered. All providers should choose an outsourced medical billing company that provides services like coding, collections, consulting, credentialing, education/training sessions, enrollment, and provider portal registration. Some outsourced companies also offer additional services, such as patient registration, insurance verification, prior authorization, scheduling, and customer service. By taking advantage of all services necessary for the practice to operate effectively and efficiently, you reduce the headache of dealing with unreliable direct-hire staff, which has become a commonality for many practices, especially since hybrid and remote positions have become the norm.
A report of findings for established practices is a practical first step for the provider to learn how the outsourced medical billing company will perform for them. It is not uncommon for the company to charge a fee for this service, but either way, it can be beneficial for established practices.
Contractual agreements should be read in detail and fully understood by both parties. Reputable outsource medical billing companies welcome feedback from potential clients and will customize the agreement to meet the provider’s needs. When reviewing the contract, be certain that it includes all services that you have chosen to receive at the rates agreed upon. The contractual agreement should also allow at least a sixty-day “no fault” by either party termination clause and an automatic one-year renewal, unless a new contract is deemed necessary by either party. Obligations of both the outsourced medical billing company and the provider should be included.
A complete understanding of the cost of services that the provider needs will allow them to make an educated decision to outsource or hire staff directly. Providers should request a fee schedule or estimate of all services provided by the outsourced medical billing company. In many instances, outsource medical billing companies are more cost effective and efficient than direct-hire staff because a team is in place to address the provider’s needs.
Reports are ideal for determining the performance of the outsourced medical billing company. They are also used for reference for any new payment trends and/or denials/rejections. When researching outsource medical billing companies, make sure you can obtain reports as often as you see fit. Remember, though, these companies should always be proactive in noticing any trends; the reason for outsourcing medical billing is to benefit the provider. If you’re spending too much time analyzing the reports, that defeats the purpose of outsourcing.
The method(s) of communication should be included in the contractual agreement. Two examples are secure emails and a separate cloud-based point of reference. These should be specific; for example, include the email addresses of the point(s) of contact for both parties and a secure website and/or portal to share reference materials, etc.
Providers looking to outsource should request at least three references and make contact with all of them. Questions to ask the references include:
- How effective is the communication between the outsourced medical billing company?
- Does the billing company tend to be proactive or reactive when noticing trends?
- Is the company successful in managing the revenue cycle?
Feel free to ask any other questions that address specific performance as it relates to their practice.
Providers who do their homework in choosing the right outsourced medical billing company to suit their needs will save time and money, reduce frustration, and promote better well-being for the practice and patients.
Outsourcing your medical billing to StarkBilling eliminates the time-consuming process of providing continuing education to staff in order to keep up with insurance and HIPAA regulations. Contact us today.