It's no secret that the healthcare is inundated with paperwork. Many medical professionals claim they spend more time filling out forms than actually treating patients. A large portion of the endless pile of paperwork is related to coding, submitting and processing medical claims related to physician or medical billing.
With no end in sight to the volume of paperwork associated with managing a medical practice, more and more practices are outsourcing their billing function to third party companies. In this article we take a closer look at medical billing in general, issues related to medical billing and the types of service providers offering medical billing as a third party service.
Services and purposes
Generally speaking, medical invoicing is the process of facilitating payment from patients and insurance carriers on behalf of healthcare providers. More specifically, billing refers to the process of submitting medical claims to medical insurance carriers and patients in order for healthcare providers, to receive payment for services rendered. In addition to submitting claims for payment, medical-billing includes the service of following-up on denied or non-adjudicated medical claims in order to rectify payment errors or total lack of payment.
Issues
One of the most common problems that healthcare facilities face is payment collection. Payment collection has historically been an issue for healthcare providers resulting from a complex system of rules, regulations and participants. Payment collection issues range from inaccurate coding or untimely submission on behalf of the physician's office to patient population demographics and insurance carrier policies, procedures and practices. The overall result is a complex and inefficient system that frequently results in rejections, denials and underpayments of up to 50%.
Many medical offices are ill-equipped to manage the arduous task of billing and as is such turn to service providers for assistance.
Service Providers
There are over 7000 medical-billing service providers in America, and as is such the sophistication and organizational structure of these businesses varies greatly. In general however, medical billing service providers can be categorized into 2 distinct groups; Home businesses and Practice Management companies.
Home business medical invoicing companies are typically small organizations with 1-2 employees. Many proprietors of these types of organizations received training and have past experience working in medical practices. These companies service between 1 and 3 clients and essentially act as an extension of the medical practice for which they provide billing services. The primary advantage of working with a home based biller is the high level of customer service they often provide. This however is highly correlated to the individual proprietor and not indicative of the group as a whole. The primary disadvantages to home based billers are the difficulties in servicing multiple clients simultaneously, limited knowledge base, and access to technology.
Practice management companies are generally larger institutions with between 10 and over a hundred employees. Practice management companies typically employ institutionalized processes to manage all aspects of medical billing. In addition to medical billing, practice management companies often provide additional value added services such as scheduling, coding, credentialing assistance and third party application interfacing. Practice management companies benefit from economies of scale that allow for high levels of technology and knowledge that can be distributed more easily across their client base. In addition, practice management generally have the ability to rapidly add and service new and multiple clients given the size and scope of their organizations.
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Medical Billing Services Introduction and Overview
6 Benefits of a Medical Billing Service
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.
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Effective medical billing service
This is a very effective and useful service for the ailing people. This service has been made in recent time. This service has been made to provide help to those ailing people who are not financially strong and are not able to continue their treatment in a proper way. For all those this is a very effective mode of service as these people are getting medical service in the form of medical claims which they are getting from the insurance company. The insurance company gives the compensation amount to the patient who claims the compensation.
This medical billing service has been made for the welfare of the people. The most important thing in this medical billing service is the medical bill which is submitted to the insurance company and the payment is made on the bill. the bill contains all important details about the patient like the patients name, address, the name of the disease from which the patient is suffering from, the name of the physician under whom the patient is doing his or her treatment etc. these are the important details which are required by the insurance company at the time of giving the payment to the claimer. This information is very important information which is required by the insurance company.
If there is any single information is missing then it is quite difficult to get the payment from the company. So the medical bill should be made very carefully. Preparing the bill is not an easy task. Previously it used to take much time in preparing the bill but this task has been made much easier as it can be made within a few days and the process of making it has also become very simple. All these things have become possible due to effective billing software. This billing software has been made in recent times which made the task of preparing the bill very easy.
Medical billing service has been made to help the poor people. The compensation amount is very much vital for these people. With the help of this compensation amount they can continue their treatment. so this medical service is very useful to them. For getting the compensation amount the patient has to submit a medical bill to the insurance company. The insurance company first analyzes the bill and then made the payment. Now this whole billing process takes 10 to 15 days, because it has been made faster with the help of billing software. This billing software is not only used in making bills but also used in keeping the data of the patients.
Article Source: http://goarticles.com/
What Does A Medical Billing Service Do For Your Doctor?
With the large number of medical insurance companies available it can be difficult for doctors offices to be able to serve people with as many different insurances as possible. Each insurance company has it's own various rules and regulations regarding what procedures are paid for, in what way and how much the maximum allowable billing amount is. Insurance companies also using a coding system which is supposed to make the billing procedure easier, however with different coding systems for different insurances it can become an incredibly complex procedure.
There are various option for a doctors office to meet the demands of dealing with insurance companies. They may hire more staff who specialize in billing insurance companies, unfortunately these costs will need to be recovered from somewhere and it is often met by necessarily increasing the cost of treatment to the patient. Another and equally undesirable option is to remove service for as many different types of insurance plan, this option means that care will not be available to as many patients as their insurance will no longer be serviced by that doctor. What can be the most convenient option is to hire an outside medical billing service, these companies specialize in completing the complex task of insurance company billing and negotiation without having to hire an in office specialist.
Depending on the medical billing service they will offer rates dependant on the amount of billing they pass on to an insurance company. The specialist medical billing service will have teams of experts on individual insurance plans and coders who understand the complex system that the plans have created to obfuscate the medical billing process. The convenience they offer for a doctors office can lead to less time spent concentrating on the billing process and negotiation with insurance plans and more time spent with patients seeing to their medical needs.
What a medical billing service offers to the individual patient is most importantly the lack of errors in submitting to insurance, with the teams who are specialist in insurance billing it is less likely that a mistake will be made with the billing process. This means that the cost of the procedure is far less likely to be passed back to you, meaning that you will not have to contact your insurance plan provider yourself to correct errors in billing issues. In many cases medical billing service will handle not only billing insurance companies but the billing of individual patients who lack insurance or who have procedures that are not covered by their plan. If a patient is offered a payment plan by the doctors office then it can be arranged and maintained by the outside billing service. If a patient does not remit payment for procedures that have been performed then the medical billing service can handle the process of starting collection on delinquent bills.
Article Source: http://goarticles.com/
Outsource Medical Billing Services - Get Help of Experts
In presents time many administrative difficulties aries during the preparation of insurance policy procedures and dealing with complicated billing forms in this condition outsourcing these services help you in many ways. Outsourcing medical billing services has become very popular right now as a booming business in the modern age. There are number of leading outsourcing companies offer assistance to your needs. Medical billing outsourcing assists doctors in saving money through payroll generation, equipment reduction, elimination of postage, and with software support.
Outsourcing medical billing service is the answer for those looking to make their medical practice more effective. It provides all types of administrative help in managing billing. There are many ways to send claims information to the medical billing service provider. You should prefer one that accepts claims information via a web browser or a software system hosted on your computers. Such data transfer is secure, efficient and less prone to error. Sending claims information on paper or via email is highly inefficient and error prone. These services provider are HIPAA approved, they manage your entire billing process, track your accounts, submit claims to the claims clearing houses and pursue the rejected claims.
Medical billing and coding are vital parts of the billing process because from the time a doctor sees a patient to when the paperwork is forwarded to the insurance company, there are important steps that need to be performed. Every doctor visit results in the utilization of medical coding skills - both are necessary for doctors and health care facilities to be properly compensated for services.
These Service has to be far more proficient and effectual when compared with your own office system. The Medical Billing Services providers should let you and your people highlight on practicing medicines. By outsourcing your requirments to your offshore partner you can save your valuable amount of time and money.
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Why Should Outsource Medical Billing Services?
Are you looking to improve effectiveness of medical billing practice? Do you need to decrease headache of in-house medical billings process and want to free from concerns of medical billing? Are you unable to keep speed with complex and ever changing system of billing codes? If yes, then outsource medical coding and billing needs at trusted medical coding and billing company. In addition medical claim billing outsourcing service can significantly increase your collections and reduce denied claims.
What are the Benefits of Outsourced Medical Claim Billing Services is a common question in our mind.
Medical claim billing outsourcing service is concern with short time as well as long time cost saving rate. Though outsource medical claim billing, you do not need to hire full time medical billing specialist for your medical coding and billing requirements.
By outsourcing you can save your valuable time and money. In the long run, these services greatly increase your overall income.
There are various advantages of medical claim billing services some important are described here:
o It reduces the time your staff spends on processing claims. You may be able to eliminate most of the staff and thus save expenditure on their health care, salary, insurance and training.
o It usually performs better than the in-house staff. They keep their staff updated on insurance regulations and codes. It lessens number of denied and rejected claims. They are also quick to resubmit the claims returned from clearing houses.
o They have bigger incentives to increase collections as they are paid a percent of the amount they collect.
o Their turnaround from clearinghouses is faster as they process large number of claims with them.
o It saves money by reducing your costs and increasing collections of delinquent account.
Offshore Medical Billing is well known health care outsourcing organization having years of experience in the health care industry.
Article Source: http://EzineArticles.com/
Medical Billing Services - Top Five Criteria For Selecting the Right Service Provider
A medical billing service can improve the efficiency of your billing system, reduce denials, cut down operating costs, boost reimbursements and save valuable time that can be devoted to patient care. These services are better equipped to adapt to continuously changing billing codes and industry requirements.
But can a medical billing service deliver the promised results? Yes, it can. However, to find the right medical billing service for your practice you will need to undertake a comprehensive evaluation, one that transcends the regular performance track record metrics. The following five criteria will enable you to identify real expertise from market hype and find a reliable, long-term medical billing partner:
1. Quality of resources assigned to your account
The best criteria for selecting a medical billing service provider is evaluation of the number of employees assigned to the account, and their expertise. Before hiring a service provider, consider the following aspects:
* Number of employees who will support the account and their credentials.
* Length of experience of the employees.
* Experience in practices specialty. Many agents specialize in collecting a specific type of claim, such as nephrology, chemotherapy, radiology, cardiology, or vision care.
2. Commitment to regulatory compliance
As a medical practitioner, you are directly responsible for complying with legal regulations, whether or not you outsource collections to a billing service. For example if a billing service changes codes to increase collections, you will be held responsible for any regulatory incompliance.
To assess how well the service providers follow regulations, ask them to give you a list of compliance policies and procedures used by their staff. Also, inquire about the training and methods that providers' use to inform their staff about current state and federal rules, regulations and guidelines.
3. Dedication to maintain customer service standards
A medical billing service, which interacts directly with your patients, has a significant impact on the reputation of your practice and customer satisfaction. Therefore, the service should meet your customer service standards and project the right image of your practice on patients. A professional billing service will always have published customer service guidelines for its staff to follow and will review these guidelines with you before attending to your patients.
4. Performance and Accountability Metrics tracking and reporting
When you outsource billing responsibilities to a service provider, you should have comprehensive performance metrics to evaluate their performance. Ask potential providers about their standard performance benchmarks and productivity measures, and whether they regularly review employee performance. Professional medical billing services maintain their accountability by regular updates on performance and progress through monthly overview reports and account receivable reports. Additional reports must be made available to you when using a software-based or web-based billing service. Reports must be clear, easy to read and sort for different types of information. Get sample reports from service providers to determine if they meet your requirements.
5. Use of IT resources and billing software
Ask the service provider about the medical billing software and other technology resources. Evaluate their security features and ease of use. Additionally, if the service provider owns the medical billing software, ask about the frequency of updates.
Several billing services have now moved towards electronic claims submission. In this case, you must assess their technology solutions and automated systems, their security and how often the systems are updated to keep pace with industry changes.
Assess potential medical billing service providers on the above-mentioned criteria to identify the right medical billing partner for your practice and reap the rewards.
Article Source: http://EzineArticles.com/
