The choice Questions to Ask before you Outsource Medical Billing to use the services of a medical billing company frequently depends on both cost and specialty for many doctors and other providers. Although these are entirely reasonable worries, the overall picture is much more complex. What to anticipate if a claim is rejected or denied is something you should be aware of. What tracking reports will be generated, and how simple will it be for you to log into your account? This article discusses five of the most crucial aspects of outsourced medical billing and explains why you should get clarifications before you sign a contract.
How long has your company been doing medical claims processing?
You require a company whose billers have common sense and experience, especially within your specialty, because the field of medical billing is becoming increasingly complex, especially with the adoption of ICD-10 codes and other significant changes. Although having certification is a very good thing, most experts agree that it cannot replace the experience gained from dealing with a variety of claims over time.
You should also find out if you will have a specific point of contact in case any questions or other problems come up. Knowing up front if the business intends to assign a regular biller to handle your daily claims and other receivables can be useful if you have questions on a specific claim, as as well as what happens if your biller takes a vacation or becomes ill in order to maintain a constant level of service.
How does the business keep its staff informed of the most recent legislative changes? Additionally, find out how they keep an eye on things and gauge the effectiveness of their billing. What standards are used to measure performance, and what constitutes a good, fair, poor, or indifferent effort on behalf of the client?
Will your system be compatible with the one I currently use or will I need to a new one?
In the event that conversion is required, how much will it cost and how will your business assist in the transition process? Though you should be adaptable and open to some change, keep in mind that you probably already have pricey practise management systems in place. You shouldn’t be required to completely redo everything to satisfy your billing company.
What measures are taken to protect data and how secure is the company’s system? The service’s HIPAA compliance level. A designated HIPAA security person must conduct regular evaluations and keep track of the organization’s compliance status.
Inquire further about business associate agreements, email, fax, and data security.
What services am I getting for my billing costs?
Of course, you want to know how much it will cost and what you’ll get for your billing money. Although it may be tempting to make a small cut, you always get what you pay for in life. Follow-up on small-ticket claims, sending patient statements, and working accounts receivable—how many are past due by more than 90 days—are some services that are typically expect but frequently not provide by less expensive businesses.
• Managing the resubmission of denied claims
• Notifying provider clients of any potential contract issues
What reports can I expect to receive?
You should find out what the billing company typically sends out as well as whether you will have “real time” access to your account and the ability to run reports. It’s likely that you’ll want to have access to claims and run reports from within your own system. To get a good idea of the data that will be provided and whether they will reveal information about both your business and their performance, ask the company for a set of sample reports. You should typically receive reporting on the following, at the very least:
- Credit balances;
- Aged Account Receivables;
- Denial Reports
How will your company handle denied, rejected or unpaid claims?
While some incorrectly equate these terms, they are not the same:
• A reject claim is one that cannot be enter into a payer’s systems for processing because it does not comply with their data requirements. This could be as simple as a patient’s insurance account number that has a digit in the wrong place. An amend claim may be submit for consideration after the errors have been fix.
• Claims that were deniel have been submit, process, but not pay. These claims cannot simply be resubmit. Without understanding the grounds for the denial and the request for an appeal or reconsideration. Denials can be the result of incomplete information, double billing, or non-cover services, to name a few.
• A claim that has not yet been pay is typically eligible for payment but may have go unnotice and never. Submit, or it needs to if it is still within the deadline, resubmit. The main causes of unpay claims are negligent billing practises.
Given that denied claims are a significant source of lost revenue for most practises, every practise needs. A policy in place to handle them. The ideal denial rate is five percent or less, but all denials. Must be monitor and analyse through denial reports to ascertain. Whether specific payers are to blame, whether particular services are being single out, or if there are other factors.
By taking measures to identify and eliminate the causes through a predictive analysis and regular audits of the quality of the chart documentation to catch issues before submitting, a good billing service should be able to reduce the likelihood of this happening.
When you decide to outsource your medical billing services
Choosing to work with a medical billing service is not a decision that should be make hastily or carelessly. Make sure to take your time researching, looking at both online reviews and conventional word-of-mouth. Since 2002, M-Scribe has assisted practises of all specialties and sizes with their billing, audit evaluation. And other revenue management concerns as one of the top medical claims billing and practise management services. For a free analysis of your practise and to learn how. We can increase revenue while ensuring that it complies with all relevant regulations,