In the days before HMOs and PPOs, deductibles and co-pays, a satisfied patient might have paid his doctor by bartering a service (such as a carpenter fixing their doctor’s creaky porch), presenting baked goods, or offering whatever cash they could muster up.
While it would be lovely to barter a transmission rebuild for an endoscopy, the U.S. healthcare system doesn’t work that way. As modern and complex as today’s medical procedures are, what may be even more complicated is the administrative activity that happens behind your practice’s reception desk. For many of those practices that have more claims, billing, and HIPAA specialists than medical professionals on staff, working with a medical billing company makes sense. A good medical billing company can benefit a medical practice in a number of ways – from lowering the bottom line to freeing up revenue to bring on more medical staff. But how does a successful, busy practice go about selecting the best medical billing company for their unique needs? Here are five questions to ask a new medical billing company.
While no two medical practices are alike, every practice must depend on revenue to function. The full lifecycle of processing claims, billing, and collections should be streamlined and seamless. How does your prospective billing company plan to increase efficiency and revenue? Is their focus on reducing denials? Streamlining the process? Ensuring proper coding and automating techniques? What are their timelines like, and are they guided by realistic goals and measures? Most importantly, are they willing to design processes that sit well with your revenue cycle and will they be a responsive partner to ensure your practice’s long-term success?
Coding isn’t just a matter of plugging numbers into a database; it’s about understanding data. On average, 80% of claim rejections are due to the wrong code being entered. “Under coding” or simply using general vs. specialty coding will have a dramatic effect on your bottom line and will constrain your revenue flow. Coders who are certified by both the AAPC and the AHIMA not only demonstrate competence with regard to accurate and efficient coding, they must maintain active credentials and earn continuing education credits to retain that certification.
Statistics show that 20-30% of claims are rejected, and 80% of those claims go unprocessed. Denied claims reduce or delay incoming revenue, creating bumps in the road that impact patient trust and confidence. Lack of communication between patient, insurance company, and your practice only makes matters worse. And don’t expect these matters to resolve themselves. Devising a denial management solution is essential to keep the revenue flowing while still ensuring customer satisfaction. Without an organized system in place, most denials fall to the wayside until months – maybe years – later, or when collections are called in. Staying on top of denial management is a critical task of a medical billing company. Be sure to ask them how they propose to do this for your practice.
Insurance plans differ from state to state and group to group. Can your billing company differentiate between extended coverage vs. federal minimum requirements? Do they understand Tricare, VA medical, Medicare, and Medicaid? Be sure to ask if their understanding of contracts is in synch with the insurance companies you accept and the services you provide.
Medicare fee schedules are updated annually, and when they are, you can expect there to be a lot of changes that can affect reimbursement values. Revised fees can add hundreds – even thousands of dollars to your reimbursement costs. If your medical billing company does not stay current with these changes, your bottom line will feel it.
Let’s face it, medical professionals don’t want to spend their time navigating an endless maze of financial data, medical coding, and revenue recovery. They want to help people be healthy while cultivating a thriving medical practice. ProMD understands that. By outsourcing medical billing services to ProMD, your practice can increase revenues 20% or more within 90 days. Leave the medical care to your staff and the back office work to ProMD. To learn how we can take the burden off handling your billing functions while helping you pinpoint financial opportunities to drive your practice revenues.
To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.