Medical Billing Companies — A Few Tips…

October 25, 2017

Over the past years, Medical Billing has become more complicated, cumbersome and expensive. It is no wonder medical practices are outsourcing their billing to a specialized billing company.

If you are considering utilizing a billing company, there are infinite questions to ask and decisions to be made. It isn’t all about the money, rather it is about having the knowledge of the many processes that will ultimately determine the financial success of a practice. Providers may see a huge volume of patients, but if the billing is not performed correctly, timely and compliantly, they will never see the full rewards of their efforts.

There are numerous articles and references on the web to educate a Provider on how to interview a billing company. Provided below are a few tips to assist in making the appropriate choice for your practice.

  1. Do not always select the company that is recommended by your peers. Since medicine is so highly specialized, so are many of the billing companies. Not every company may be proficient with your specialty. Therefore, they may not be familiar with the billing guidelines involved in submitting a “clean claim” and receiving appropriate payment. This is especially true with surgical specialties.
  2. Inquire if their billing software includes CCI edits prior to claim submission. If the vendor does not know what a CCI edit is – end the conversation and start your search again
  3. The billing software should utilize a clearinghouse to validate claims through an eligibility program prior to claim submission. Of course, the insurance eligibility function should be performed prior to a patient being seen, but if not performed initially, the claim should be identified and corrected prior to submission.
  4. Surgeries and office-based procedures contain multiple CPT codes for a single date of service and modifiers are a big part of appropriate claim submission for these types of services. Modifiers can easily add hundreds of dollars to a claim, as well as remove. Although modifier assignment should be the responsibility of the Provider, “Modifier Management” should be discussed, in detail, prior to contracting with any billing vendor.
  5. Communication between the billing company and the Provider is essential. Most billing companies will prepare a monthly reporting package for the practice. There are multiple types of financial reports that can be generated from a good software system, some useful and some not. A Provider needs to understand the intricacies of these reports and review them appropriately. A good billing vendor will have the ability to report on each level of detail for every claim, carrier, procedure code, diagnosis, claim submission date, claim paid date, amount by procedure code, age of claim, etc.
  6. It is imperative that a billing company communicate to the Provider the types of denials they are receiving on their claims.

Are the denials…

  • Registration based?
  • Coding based?
  • Eligibility Based?
  • Insurance Company specific?

As the Provider, you need to know what changes may need to be made in the office workflow to cut down or eliminate certain denials.

Selecting a billing company is a significant decision that will impact your practice. Seek professional advice prior to making this decision. If you are currently utilizing a billing company, be sure to pursue the services of a professional who can perform a billing assessment to ensure your operational success.

By Susan Genrich, CMM, CPC

Consultant, RR Health Strategies