Role of Medical Billing Services in Maintaining a Successful Practice

Every practice has a growth curve which demands meticulous care and attention. By hiring medical billing services, practices seem to reach the peak of that curve at a faster rate. Now, staying at the top is not easy. With right guidance and assistance form professional billers, practices can maintain their status quo of being profitable.

Core services provided

Let us look into the responsibilities taken up by medical billing services at your practice 

• Processing claims and submission

Medical billing services gathers all the right information required to process a flawless claim for every patient at your practice. Now, though this sounds simple, in actuality processing a claim is a very complex and demanding task. Starting from the patient information and policy details, every step and detail needs attention and expertise. Which is why a professional billing service is hired to manage the task. After a multilevel screening and auditing, the clam is electronically submitted to the insurance payer for further review.

• Denial management

However, not all claims get accepted by the payer for reimbursement. Many at times, the insurance companies come up with further demands on clarity and revision on documentation before accepting the claim. The medical billing services play an important role in managing denied claims. For one, they keep track of every claim sent out from your practice. This way, they start tackling the denied claims faster than your inhouse billing staff. With pre-set strategies and an appeal process, they negotiate with the insurance companies to procure the claim.

• Payment collection

Now, collecting payment involves not only from the insurance companies but from the patients too. With state- of- the- art patient engagement services, professional billers help you stay connected to the patients till the very last penny of liability is collected and resolved. 

• Recommendation on process improvement

Medical billing services are adept in good clinical practice methodologies which enhances the revenue and reputation. Be it, marketing strategies to increase patient referrals and good reviews or revenue inflow, they can guide you through and through. Professional services conduct periodic audits and multilevel compliance checks till the work flow is tweaked to perfection.

Features that improve the practice’s revenue cycle

• Preauthorization services – 

Most companies offer to preauthorize the patient for the treatment preferred. Billing company looks in to the details of the patient’s insurance package. One cannot stress on the importance of this step enough, because claim is often denied due to lack of proper coverage. 

Hire a service, that looks into the insurance status, validity of the plan, treatments and benefits covered, pharmacy benefits, payment criteria by the payer and more. And most importantly, make sure that you as a provider or facility belongs to the network of the particular payer the patient is subscribed to. This way, one can avoid all the possible glitches pertaining to coverage issues, in getting paid. 

• Credentialing services – 

Talking about entering the insurance company’s network of providers, professional billers also offer credentialing services to new providers at the facility. In this essential service, they help you get enrolled with maximum number of insurance payers in the locality. So that you can take up any number of patents with varying insurance subscriptions. 

Now, credentialing is a time consuming and complex task which requires professional assistance. Count on the professional credentialing services to get it done at the earliest so that the provider can start sending out bills for claims. 

• Professional coding standards – 

Anybody can conduct the coding part on a diagnosis or treatment procedure but it takes a professional to assign codes of highest specificity for bill capture. Errors in coding not only invites frequent denial of claims, it might put you practice in legal risks too. 

Maintain compliance with coding process is of paramount importance. With professional medical billing services, you get trained coders and billers to capture very possible billable scenario coded with utmost accuracy. Furthermore, these codes undergo repeated audits and compliance checks to make sure chances of denial are minimal.

• Clean scrubbing and clearing house services – 

Professional billing services make use of latest technology clean scrubbing software’s which are programmed to pin down problematic claims to 99 percentile efficiency. Also, they have integrated clearing houses that screen the claims prior to submission. Any day, it is better to work and rework on the claim till it is zen percent error free rather than facing repeated claim denials. 

• Managing the account receivables – 

Working on the account receivables is a major pain for any administrative staff at the practice. With multiple payers and numerous bills at different stages of payment. It is hard to keep track of everything at once. Yet, it is the core of your practice’s revenue which demands critical attention. 

Medical billing services look into all the ageing account receivables at the practice and sort them out as quickly as possible. Equipped with a designated team of specialists. They analyse such claims based on their reason for delay and work on it methodically till full payment is collected.

In a nutshell, professional medical billing services can take your practice a long way with respect to process improvement and profitability. Make sure to choose the right company to partner with, for a successful practice.