How to Choose the Best Medical Billing Service for You

Choosing a reliable medical billing service is one of the most important decisions a medical practice can make. The best medical billing service can help you make more money, decrease denied claims, follow the rules, and have more time for patients.

Before choosing a medical billing service, carefully evaluate potential partners to find the best option for your needs. This guide covers key factors to consider during your selection process.

1. Clearly Define Your Practice's Needs

Think about your practice’s needs and goals when choosing a billing partner. Choose wisely; it’s crucial. Important factors to think about are:

  • Current Billing Challenges – Find ways to make money and work more efficiently. It can include reducing unpaid bills, decreasing rejected claims, speeding up payment collection, and finding missed revenue.
  • Revenue Goals – Create goals to improve metrics using standards specific to your industry. It means more money collected on time, fewer late payments, and better success with insurance claims.
  • Staffing Constraints – When hiring someone to handle billing follow-up, ensure they can cover staff shortages to avoid issues.
  • Compliance Factors – Find the skills to choose the correct diagnosis and procedure codes. Check for errors before sending to avoid audits. Stay updated on new rules and regulations.
  • Reporting Needs – Find required reports (claim status, aging summaries, denial reasons) and how often they need to be generated.

Related, Can Medical Billing Services Help Grow Your Practice?

2. Seek Industry Experience and Expertise

Looking at past results can help ensure service will bring in similar revenue for your company. Look for,

  • Client References – Speak to past clients with similarities to your practice—probe satisfaction by improving KPIs like clean claim rates, collections, efficiencies, etc.
  • Online Reviews – Review other websites for ratings and feedback on communication, education, reporting, and denial handling.

Review Case Studies – See client success stories with better stats and positive service feedback.

3. Check References and Reviews

Looking at past results can help ensure service will bring in similar revenue for your company. Look for,

  • Client References – Speak to past clients with similarities to your practice—probe satisfaction by improving KPIs like clean claim rates, collections, efficiencies, etc.
  • Online Reviews – Review other websites for ratings and feedback on communication, education, reporting, and denial handling.
  • Review Case Studies – See client success stories with better stats and positive service feedback.

4. Evaluate Software and Technology

Robust medical billing software, automation, and analytics are essential for efficient billing operations. When vetting services, prioritize advanced platforms integrating into your existing health IT ecosystem.

Key aspects to review include:

  • EHR Integration – Find ways for electronic health record software to sync automatically with billing systems for easier management. It removes the need for manual data input or transfers.
  • Workflow Automation – Check if it can fix common claim mistakes, track staff tasks, and simplify billing tasks with rules. It prevents manual inefficiencies.
  • Reporting – Ask for updates on claim status, denial reasons, payment time, and collections to stay informed about your finances. Data must be visible.
  • Patient Portal – Visit the website to see if there are any billing updates or make payments. It helps staff answer questions about status.
  • Business Intelligence – Check the dashboard for revenue, reimbursement trends, practice growth, and benchmark comparisons.
  • IT Infrastructure – Make sure the hosting is set up correctly. Keep data safe and do regular backups. Additionally, ensure solid plans are in place to keep the website online.

5. Confirm Strong Client Support Resources

Even robust platforms require knowledgeable people to support their use. Vet the client services team to ensure responsive issue resolution and guidance tailored to your needs. Consider:

  • Support Channels – At a minimum, confirm phone, email, and chat options with support teams.
  • Availability – If necessary, provide hours for employees to seek assistance, even outside of usual office hours.
  • Average Response Time – Ask for agreements that define how quickly issues will be addressed to show how responsive a service is.
  • Staff Training – Train your team with initial training and ongoing webinars/guides to keep up with changing regulations and tools.
  • Client Success Managers – Look for account managers who can help find opportunities and give advice based on data.

6. Verify Strict HIPAA and Data Security

It’s essential to keep practice data secure and follow healthcare security rules, says LinkedIn. When using a third party make sure they,

  • Follow HIPAA and HITECH rules to keep data safe with access controls, encryption, transmission security, and breach protocols.
  • Pass SOC 2 Type 2 audits to show security controls and staff training for cybersecurity are in place.
  • Provide transparency into policies, systems, and reports like penetration test results upon request.
  • Maintain cyber liability insurance policies covering any potential breach response costs and damages.

7. Compare Cost Structures

Pricing models, contract terms, and fees vary widely among medical billing service providers. Conduct an ROI analysis before selecting the most cost-efficient, value-driving option. Consider:

  • Pricing model tradeoffs (percentage of collections vs. packaged rates)
  • All one-time and recurring fees
  • Guarantees buffering risk like performance minimums
  • Options for scaling fees aligned to practice growth
  • Criteria and notice periods for any rate hikes

8. Review Company Size and Resources

Company size impacts service customization, access to staff, and technologies leveraged. Consider tradeoffs when reviewing operations:

1. Large Billing Firms

  • Boast economies of scale and maximize automation, analytics, and platform infrastructure.
  • Offer a breadth of specialty experience but less custom service delivery catered to each practice.
  • Higher client-to-staff ratios limit direct access to support specialists.

2. Smaller Billing Firms

  • Provide specialized expertise with highly attentive, tailored services.
  • Customize offerings around individual practice needs and objectives.
  • Have lean teams driving more limited technology capabilities

9. Don't Overlook Performance Guarantees

When picking a medical billing service, find explicit guarantees supported by measurable results for the best results.

  • Increased net collections by an agreed-upon percentage within six months
  • Lower accounts receivable days by 10% year-over-year
  • First-pass claim acceptance rates improved from the current baseline.
  • Routine reporting on metrics showing improvements

10. Confirm Robust Denial Management Capabilities

Even with the best medical billing service, some claim rejections will occur. Compare partners on their denial management process:

  • Dedicated teams focused on denial root cause analysis and appeals.
  • Use of automation to flag and fix commonly denied claims preemptively
  • Full-service appeal filing for improperly denied claims
  • Ongoing analysis to prevent future rejections
  • Performance reporting summarizing denial rates and reasons.

Strong denial management ensures you receive your total compensation for billed services promptly.

11. Set Clear Communication Expectations Up Front

Assessing communication responsiveness early on provides insight into more significant reliability issues:

  • Note contact quality and timeliness from your first interactions
  • Define expected response times by communication channel
  • Specify standard modes and cadences to receive status updates
  • Confirm direct staff access via phone, email, portal, etc.
  • Request sample reports demonstrating proactive insights.

Setting clear communication expectations early drives better ongoing engagement with your billing partner.

The Final Words

An exemplary medical billing service is crucial for your practice’s financial health. Take time to thoroughly research potential services, ask questions, and check references to find the best fit. The best medical billing service will have lots of experience with medical billing and will take the time to understand your practice’s needs.

Price is important, but quality is more important. A good billing service will help you collect more money and avoid claim denials in medical billing. To pick an excellent service, determine what you need, create a request, check references, and look into qualifications. This will drive improved cash flow, fewer claim denials, and better financial performance.

Book a free consultation with our medical billing experts today to boost your practice’s revenue. Our customized services deliver proven results.

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