As a healthcare professional, you’re faced with a lot of administrative tasks and patient care, with medical billing being one of the most intricate tasks. Medical billing services are offered for medical practitioners, including clinics, hospitals and private practices to ensure their insurance claims are correctly submitted, follow-ups are done with unpaid balances and are paid promptly.
So, what exactly are medical billing services?
Medical billing services include a series of administrative and financial processes that ensure accurate patient registration, insurance verification, claim submission, and reimbursement for healthcare providers.
People who attend the clinic must be registered and their eligibility verified before appointments, if they have insurance coverage.
- Medical coding — converting diagnosis and procedures to CPT, ICD-10 and HCPCS codes.
- Claim submission__ Accurately submit claims to Medicare, Medicaid, and/or private insurance companies
- Payment posting — keeping records of payments to and from insurers and patients
- Denial Management — The process of finding, appealing and remitting denied claims.
- Chasing of the unpaid balances systematically
- Accounting for patients’ bills and collections — sending statements and arranging payment plans
- Reporting and analytics — giving financial dashboards to providers to assist them in tracking performance
The Medical Billing Cycle:
- Patient scheduling and pre-authorization — Insurance eligibility is checked prior to visit.
- Patient check-in – collection or updating of demographic and insurance data.
- Medical documentation — The provider completes medical documentation in the EHR (Electronic Health Record).
- Medical coding – Certified medical coder appropriately codes the diagnosis (ICD-10) and procedure (CPT) codes.
- Claims are created — Billing team puts together a clean claim that contains the necessary information.
- Claim submission — Claim is electronically submitted to the payer (insurer).
- Adjudication — Insurance company reviews and processes the claim. This payment is made or a denial notice is sent providing a reason code.
- Denial appeal (if applicable) — Billing staff corrects claims and resubmits.
- Patient statement — If there is any balance left, the patient is billed for the balance.
- Collections — Outstanding accounts are followed up by a phone call or payment plan.
There are various types of medical billing services available:
Everything you need to maximize patient collections. Complete Revenue Cycle Management (RCM):
This is the most full-length one. It is managed by a revenue cycle management company which is responsible for each and every measure from booking a patient appointment to payment. It’s perfect for fast-paced practices that desire a completely hands free invoicing procedure.
Specialty-Specific Billing:
Ø Experience in behavioural health codes and prior authorization, along with mental health billing.
Ø Chiropractors are in constant contact with medical coding and billing but often encounter several denials and payer-specific rules. Chiropractic billing involves dealing with numerous denials and payer-specific rules.
Ø Handling the billing of emergency rooms with high volume and multiple payers. Handling large volumes of emergency medicine bills and multiple payer mixes.
Ø Handling technical and professional component splits along with radiology billing.
Ø Paediatric billing – understanding vaccine codes and well-visit coding.
Clearinghouse Services:
Some payers have a clearinghouse, or technology platform that cleans and forwards electronic claims to more than one payer. These may be implemented in conjunction with existing billing personnel but are usually not used in their place.
Team Bill Software for Billed Services:
ü Hybrid models involve using billing software tools along with human supervision. The EHR-integrated billing platforms (such as Kareo, AdvancedMD or DrChrono) can have a managed services layer option.
ü When you’re looking for the right medical billing company, there are a number of things you should consider.
It’s a big decision for any business to decide whom to use as their billing partner. Consider providers based on the following:
Certifications and Credentials:
Seek out companies that have Certified Professional Coders (CPCs) or Certified Billing and Coding Specialists (CBCSs). These is the credentials that indicate trained and accountable professionals.
Specialty Experience:
Specifically ask questions: “How many clients do you have that are my specialty? and “What is your average first pass claim acceptance rate on those clients?
Transparency and Reporting:
Each month you should be able to get a detailed report that includes:
o Total claims submitted
o Denial rate by the party paying the claim.
o Average days in accounts receivable (AR): The number of days that are needed to collect a customer’s account balance.
o The percentage of the charges that are collected.
o Technology Integration
o The billing firm ought to be able to blend in with the current EHR or practice management software. Try to find out what systems they support before you enter into a contract.
Fee Structure:
The medical billing services charge 4-9% of the collection, although there are also medical billing services that charge a flat fee. Beware of companies based on submitted charges instead of revenue collected; they will not work for you.
HIPAA Business Associate Agreement (BAA):
All billing companies that process patient information have to complete a BAA with your practice. This is not something that you can opt out of doing — it is mandated by the HIPAA law.
References and Reviews:
Check on the references of practices like yours. Read complimentary reviews at third-party sites and assess businesses of at least 5 years old.
Here are the most common problems – and the solutions offered by the best billing services:
Claim Denials:
Denied claims are most often caused by one of the following:
- Wrong patient information – wrong date of birth, wrong member ID etc.
- Missing prior authorization
- Coding out of order — coding together when they should be coded separately, or vice versa
- The failure to file the writte on time (payer’s deadline).
- Medical necessity — procedure billed does not reflect a diagnosis
Coding Errors:
Denials or underpayment from coding errors, no matter how minor the error, will never be tolerated. Regular training for certified coders helps to maintain accuracy in your claims.
Payer Credentialing Delays:
New providers are not going to be able to charge patients until they’re credentialed with each insurance company.
Changing Regulations:
Billing rules are ever-changing, ranging from annual updates to CMS’ CPT codes to varying rates of reimbursement.
FAQ’S:
- What is the price of medical billing service?
The average rate is 4-9% per month on the revenue that is collected. Others have low volume pricing with flat rates per month.
- How much time is needed to get results from outsource billing?
The results are seen in most practices within 30-90 days.
- Will I lose control of my billing when I outsource?
No — you can keep track of all billing activities in real time with a real-time dashboard and monthly reports from the billing service.
- Can outsourcing medical billing work for the HIPAA?
Yes, but there is a provision of signing a Business Associate Agreement (BAA) with the billing company.
- What proportion of the total claims are good?
When the clean claim rate is high it is a thing. If the clean claim rate is 95 percent or more that is really great. A high clean claim rate, like this is what we want to see. The clean claim rate is very important. We like to see a clean claim rate that is 95 percent or more.
Conclusion:
Independent practices, small groups, and specialty clinics of all sizes are finding that they are collecting more money, dealing with less headache and spending more time with their patients thanks to professional billing support.
The proper billing partner provides certified coders, payer experience, HIPAA-compliant systems and follow-up on every dollar that your practice earns. The challenge in today’s insurance billing is that it can be very time consuming to manage it all within the business, and the cost can also be greater.
If you’re looking for a trusted medical billing partner, CareSolution MBS provides reliable, HIPAA-compliant medical billing services designed to help healthcare providers improve cash flow and reduce claim denials.
