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A Few Important Considerations When Selecting a Medical Billing Company

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Every year healthcare providers collectively lose approximately $125 billion due to poor billing practices (Healthcare Business &Technology). Problems associated with these losses include billing errors and a failure to stay up-to-date on the latest rules and regulations associated with medical billing.

To reduce these issues many doctors, hospitals, and other healthcare providers look to third-party partners for their medical billing needs to increase chances insurance companies will accept claims. Selecting a company to provide medical billing services is a decision not to take lightly. Healthcare providers should be prepared to understand several different aspects of third-party billing before partnering with a vendor.

Costs and fee structures

One of the primary factors healthcare providers should look at when selecting a medical billing vendor is cost because exploring billing options many find there is no one-size-fits-all solution. When making a decision, healthcare providers will want to factor in the number of claims they need to be processed, the size of their practice’s facility/office, and if their practice operates in different states. Questions to consider asking potential vendors include:

  • Does the company charge set-up fees? If so, how much?
  • What amount does the company charge for annual administrative fees?
  • Is a flat fee, percentage of money collected, or an hourly fee the more feasible payment structure?

The last question is essential, it’s important to understand the difference.

Percentage of money collected can result in more claims being paid because these vendors tend to be more aggressive. In other words, if the practice doesn’t get paid, they don’t get paid. The drawback for small and medium-sized practices is they can lose a lot of their profits with this type of fee structure.

A flat fee structure means the medical billing company gets a set amount per claim (averaging $4-$6 per claim) which means they’ll be more inclined to pay attention to all claims, no matter how small (Medical Billing Services Review). However, denied claims aren’t always aggressively pursued since the vendor is paid either way.

Healthcare providers with small offices might find an hourly fee structure to be the best option. Essentially, the billing company gets paid for actual hours worked. This is similar to an in-house billing specialist, but without the salary and benefit responsibilities employers are obligated to pay.

What is included in billing services?

Service providers can offer accurate medical coding, filing claims, determining insurance eligibility, posting payments, following up on denied claims, following up with patients, and sound advice on better claim filing processes.

  • Compile a detailed list of exactly what’s included (and not included) in the contract.
  • Determine what gaps the practice needs to be filled, and what capabilities and resources the vendor can offer.
  • Ask what type of transparency in the billing cycle the vendor offers.

Many healthcare providers immediately look to the bottom line when selecting a vendor. This is a critical mistake. Billing companies charging noticeably lower prices than their competitors likely won’t provide the same quality or level of services. This can lead to problematic issues down the road.

Education and certification of employees

Partnering with a medical billing vendor should alleviate the hardships associated with billing. However, for that to happen, it’s important to determine if the vendor’s employees are educated and certified to perform vital tasks.

  • Most people who work in this field typically have completed a 2-year associate’s degree or a 1-year certification program.
  • Certification is voluntary, but many vendors will seek out employees who have been certified as it only strengthens their services. The most common certifications to look for Certified Coding Assistant (CCA), Certified Professional Coder (CPC), and Certified Coding Specialist (CCS). The latter is for senior coding specialists).
  • Several other specialized areas of medical billing are available for workers to become certified in.

Taking a look at education and certification often provide health providers with a sense of confidence when choosing a vendor. Ideally, healthcare providers are best-served by partnering with a company with expertise in their particular practice area of medical specialty.

Measures put in place to safeguard data

Data breaches are serious, especially in an industry such as healthcare, where there are legal and financial repercussions for any mishandling or mismanagement of data that puts patients at risk for identity or financial theft. It’s imperative for all healthcare service providers to be well-versed in HIPAA and safe practices when it comes to handling patient data. This includes partners who perform billing tasks.

  • Look for a partner who is willing to share what software they employ and how it is run. For instance, is it a cloud-based system in one central place, or are there several decentralized pieces involved?
  • What security measures are taken to protect sensitive data in storage or in transit?
  • How are passwords stored?
  • What is the process for destroying records no longer needed?

The best medical billing companies put a heavy emphasis on HIPAA-compliant billing processes.

Bottom line, when selecting a vendor, don’t focus solely on price. Instead, look at the whole package for what level of services are received for fees paid. A few extra dollars may be worth the fewer headaches associated with the complexities associated with medical billing and coding.


Jean Delva
Founder & CEO of Symbion Coding, Inc.
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