Healthcare providers (HCPs) today must see more patients, provide more complex medical services, and complete detailed documentation more efficiently. Consequently, there is little time left to deal with billing. An HCPs’ financial stability and their medical practice’s future depend on their medical billing and coding quality.1

Medical billing and coding is the reimbursement process, i.e., payment, for services rendered by HCPs. The coding process involves classifying a patient’s condition according to the International Classification of Diseases (ICD). Currently, the ICD is in its 11th version (ICD-11). Billing is the process of submitting claims to health insurance companies for HCPs to receive payment for their services.

Even though billing practices are vital to maintaining a practice, HCPs receive little medical billing training.2 Every clinical encounter involves medical billing, and non-compliance with medical billing laws is punishable across jurisdictions.2 Medical billing and coding require precision and a lot of time, which HCPs do not have.

As a result, medical billing companies are becoming more and more necessary for HCPs and their medical practices. These companies help relieve HCPs of the burden of the reimbursement process. It is now possible to choose from a wide variety of medical billing companies. How can an HCP determine which medical billing company is best for their medical practice?

Choosing the best medical billing company is challenging. This guide will help medical practices find the best medical billing company.

What Is a Medical Billing Company?

Medical billing companies or a medical billing service handle and transfer patient information, submit claims to insurance companies, and ensure that payments for medical services are received as soon as possible. Receiving payment for services can be a long, tedious process. Medical billing companies’ purpose is to streamline the process and relieve administrative burdens from HCPs.

Clinical documentation is one of the essential components of the reimbursement process. Ensuring every patient interaction, procedure, and service is appropriately documented will help HCPs avoid claim denials. In medical billing, the golden rule is, “Don’t code and bill for anything that isn’t documented in the medical record.” By using a medical billing service, HCPs can reduce stress and improve efficiency.

What Are the Benefits of Hiring a Medical Billing Company?

Hiring a medical billing company makes the billing process more manageable. The following are some reasons why hiring a medical billing company is beneficial:

• Improves accuracy

• Increases the speed of collections

• Enhances patient satisfaction

• Optimizes clinical space

• Reduces overhead costs

• Maximizes profits

Practices should review their current billing systems to determine whether the benefits are applicable.

What Should Medical Practices Consider Before Hiring a Medical Billing Company?

If an HCP’s practice considers outsourcing the medical billing process, it helps to know the goals of the relationship. Each medical billing company has its own capabilities and services. Some companies specialize in one area, while others offer a wide range of services. Consider these 2 questions when deciding what type of medical billing support a medical practice needs.

1. What does the medical practice want to accomplish?

The most essential factor to consider is what the practice wants to achieve by hiring a medical billing company. Does the practice want to increase revenue? Or maybe the practice wants to reduce costs and cut down on administrative tasks.

Savings money may mean choosing a lower-cost option without any extra features. However, a more comprehensive solution is more appropriate if the practice wants to improve efficiency. Regardless of the practice’s goal, it should clearly understand what it wants to achieve.

2. How much support does the practice need?

Once the practice has determined what it wants to accomplish, it must decide how much support is needed. For example, if the practice wants to decrease its overhead expenses, choosing a less expensive option that provides basic support is the best option. The practice may prefer a system with additional features if it wants to increase revenue.

How Much Should a Medical Billing Company Charge?

In addition to costs, here are questions to ask a medical billing company:

• Can you tell me how long you have been in business and how long your billers have been coding?

• Are you compliant with HIPAA?

• How will I receive my reports?

• Are you able to guarantee transparency?

• Would you be willing to adjust your processes if I asked you?

• When a contract issue arises, will your operation notify me?

• Is my account affected if someone is sick or on vacation?

• Are you a member of any local, state, or national associations?

• Could you please provide me with references?

• Can you explain your pricing breakdown?

• Upon submitting claims, how quickly will they be able to process them?

• Are monthly financial reports provided?

Choosing the Best Medical Billing Company

After asking those questions, the medical practice will better understand the company and its capabilities. Before partnering with a medical billing company, ensure the company meets the following standards:

• Billing solutions are comprehensive

• Up-to-date with regulations

• Invested in the practice’s growth

• Detailed reports are provided

• Experts work for the organization

Financial performance will improve when specialists are hired for each part of the revenue cycle. Prior authorizations (PAs) are another essential aspect of a practice’s revenue cycle and can cause another administrative burden for HCPs. PAs are a cost management tool used by insurance companies. HCPs can spend approximately 14.9 hours on their PA workload.

By hiring specialists, practices can reduce administrative burdens and improve revenue cycle efficiency. Similar to hiring a medical billing service, hiring a prior authorization specialist or certifying staff can ultimately increase revenue. To learn more about the benefits of certification, visit the National Board of Prior Authorization Specialists.

References

1. Burks K, Shields J, Evans J, Plumley J, Gerlach J, Flesher S. A systematic review of outpatient billing practices. SAGE Open Medicine. 2022;10:205031212210990. doi:10.1177/20503121221099021. 2. Faux M, Adams J, Wardle J. Educational needs of medical practitioners about medical billing: a scoping review of the literature. Hum Resour Health. 2021;19(1):84. Published 2021 Jul 15. doi:10.1186/s12960-021-00631-x.