In these uncertain times, with all the changing regulations of how claims are submitted, received and processed by Insurance Carriers, it can be quite overwhelming financially. The most common questions asked are… Am I collecting the maximum amount possible? How do I know I am collecting as much as possible? How can I increase my revenue? Perhaps a Medical Billing Service could answer all of these questions and calm the angst that is associated with them. There are many benefits to a Medical Billing Service. Below are six benefits that are explored in more detail.

Increase Collection Rates with a Medical Billing Service

Many people are under the impression that Medical Billing is merely data entry; however, it is much more than that. In order to bring in the maximum amount of money on the claims being submitted there needs to be follow-up on the claims. This often times is where in-house billing falls short, depending on the amount of staff that is part of the department, claim submission and payment posting become the priorities. For instance if you have one biller in a two physician practice that sees a decent amount of patients per day, the biller’s time is mainly going to be spent on creating, submitting and posting payments for claims. Entering in the claims, and reviewing each claim before it gets sent to the insurance carrier is time consuming. This is also true with payment posting; it is time consuming to post the money received to each CPT code, yet extremely important. With just those two responsibilities, there is little time left for the claims that require more action. Most often the claims that are denied require little action in order to become paid claims. However, it does take time to follow-up with the insurance company to see what is required to get the claim paid. Follow-up alone is a full time position. With a Medical Billing Service there are multiple personnel working for your practice. Often times there is one full time dedicated person following up on all claims that require further action. Instead of paying for two full time employees most Medical Billing Services have follow-up on claims as a standard service of Claim Processing.

Increase Profitability with a Medical Billing Service

There are multiple ways that a Medical Billing Service can increase the profitability of a Medical Practice, including, but not limited to staff availability, eligibility services, and CPT trending. When you hire a Medical Billing Service you are getting multiple billers working on your account. There is constant activity with claims submissions, payment posting, follow-up, patient billing and account inquiries. If one of those billers happens to be out, there are multiple billers there to fill in, ensuring that no work is left until that biller is back in the office. This means there is no disruption in the Billing Process and no hiccup in the revenue received. Patient Eligibility is one of the easiest ways to ensure proper payment of claims. Before the patient even walks through the door, the patient has had their eligibility verified. This in turn ensures the practice that the patient is currently covered under the insurance carrier on their file, and any referral that is needed has been obtained. It also allows for any Insurance Carrier discrepancies (such as a change of insurance, mistyped ID number, etc) to be fixed prior to the visit, leading to an increase in “clean” claims, which in turn leads to an increase in profit for the practice. Another way to increase profitability with a Medical Billing Service is through CPT trending. When payments are getting posted to CPT codes, the billers often see a trend to what codes are being paid and how much is being received per code. This can often lead to two different scenarios. One being that certain codes are not being paid on, which in turn allows the practice to decide whether or not to continue to offer that service to their patients, or find an alternative or comparable service that they can provide and which will be paid. The second scenario is that the practice is performing a procedure often, therefore allowing a renegotiation with the Insurance Carrier of how much to be compensated. The above are only three out of many ways a Medical Billing Service can help Increase Profitability for a Practice.

Increase Physician Productivity with a Medical Billing Service

When a physician is confident that the financial aspect of their business is in good hands, and is not worried about whether or not claims are being submitted and money is being collected, they can focus on what is the most important aspects of a physician’s job – patient care. With a Medical Billing Service if there is a CPT code in question or a diagnosis code that cannot be found, the Medical Billing Service will be able to assist in finding that code. This in turn allows the physician to keep on seeing patients and charting without skipping a beat, instead of sitting and trying to figure out what the code is. Similar to CPT trending, which helps increase profitability, a similar trend happens when the billers are reviewing claims prior to them being submitted to the insurance carrier. The billers will assist the physicians when there is a conflict in the codes being billed or if they see something that is being repeated that will help the physician and save them time when doing their chart notes. Many Medical Billing Services offer the services of a Business Analyst who will work with the physician and their office staff and provide suggestions on how to maximize the usage of tools on hand (i.e. EMR, MAs, office flow, etc). This will increase efficiency and productivity.

Increase Staff Productivity with a Medical Billing Service

As well as offering the services of a Business Analyst, some Medical Billing Services will also offer training on how to properly register a patient, collect co-payments, and create an optimal office flow that will increase productivity throughout the office. Many office staff members do not realize the importance of their job; not realizing that they are projecting the first impression on patients that walk through the door. Properly trained office staff will give more of their attention to the patients, which in turn will be appreciated by those patients who are also more likely to recommend the physician to their friends and relatives. Along with increasing the efficiency of the office a Medical Billing Service also eliminates many patient calls regarding their accounts. When a patient has a question regarding a statement, or a bill that they have received either from the office or an insurance carrier, the call is handled by the Medical Billing Service. They are able to assist your patient in a professional manner, without the pressure of having to check in patients, answer the phone, etc. The attention and professional manner in which the Medical Billing Service personnel conduct their business will assure the patients that their questions and concerns are being dealt with properly.

Decrease Claim Denials with a Medical Billing Service

With a Medical Billing Service, the staff that is dedicated to your practice goes through each claim before it is submitted to make sure that it is a “clean” claim. A “clean” claim is what it sounds like; a claim that has the correct CPT codes associated with the diagnosis codes, complete patient information, and complete insurance information. This decreases the chance of denial by the insurance company. Medical Billing Services ensure that the highest percentage of “clean” claims possible are being submitted to the insurance carrier. This increases the revenue coming back to the practice as well as decreases the amount of labor needed to follow-up on claims. Medical Billing Services know that the time spent reviewing claims to make sure they meet the insurance carrier standards is well worth the time.

Gain insight into your practice financials with a Medical Billing Service

A Medical Billing Service knows which reports to run to give physicians complete insight to the financial side of their practice. Medical Billing Services know what money is being billed out to the insurance carriers, as well as what is being received from insurance carriers and patient payments. This is turn allows the Medical Billing Service to run the appropriate reports that show the physicians what they want to know, instead of giving reports that show miscellaneous data that does not pertain to the main financial insight of the practice. Many Billing Services are also able to provide physician requested financial reports very easily. For instance, if a physician needs to know how many specific procedures were done in a date span for Credentialing, the Medical Billing Service can easily obtain this information. Another way to gain insight into the financial side of the practice is to trend how the insurance carriers are paying. If an Insurance carrier increases or decreases the amount received, it will be seen right away by the Medical Billing Service, thereby allowing the correction or renegotiation of any discrepancy in payments.

Revenue is generated by the clinical side of the practice, meaning that physicians gain revenue by seeing patients, not by doing administrative work. Increasing time spent on the clinical side, means increasing the amount of revenue.