Why You Need Outsourced Medical Billing Services

The global economy is not doing too well. As a result, most investors are using every means possible to cut down on their operating costs. The problem is that not every option taken is as reliable. Some options lead to more problems than good. One of the best choices that any person can take is that of outsourcing for medical billing services. There are many reasons why this is a considerable choice to go with.

To start with, the outsourced medical billing services helps in accelerating individual claims. Processing all the insurance claims personally can easily take up a lot of your time. This is why it is very important to always seek help from other professionals in the market. This is an option that will help you save on time and achieve better results from the same. The professionals have a profound understanding in physician billing services and will ensure that you get the desired goals within a fraction of the time.

Another benefit is that you get a persistent follow-up on both patients and claims. As aforementioned, handling every process personally can easily strain your resources. With the professional support, you are able to have undivided attention on follow up. This means that every transaction will be handled on your behalf until the desired results are achieved. This is so to mean that you will never waste time verifying claims or contacting your patients directly. This is an advantage that has enabled practitioners to give undivided attention in their services.

Reporting is also done is a professional way. Reports are very important in both medical practice management and when it comes to the process of offering medical practice for sale. Getting comprehensive monthly reports is never easy. It is imperative that you always take time to conduct a research to find the best professional to assist you in healthcare informatics. This will help in future planning and in eluding undesired expenses.

Still on reporting, the service providers will take the time to collect and analyze every patient's information. This is done by taking all the patient logs, conducting background checks and using any information available to validate claims. The practitioner is able to gain a profound understanding of his patients.

Promptness in the posting of payments is another reason why you should consider outsourced medical billing services. The service providers have the manpower, skills and tools to ensure that all the services are handled with professionalism. This means that there are no delays in the handling of claims. You will be able to get payment for the claims within a shorter period of time. This is what has enabled investors ensure reliable business continuity.

Lastly, some service providers will go the extra mile to respond to patient's questions. This is what enables practitioners to have an ample time attending to their chores. Less time is wasted in practice management. The service providers in medical practice management can also offer assistance in analysis and recommendations for restructuring. This will help achieve better results or even add value for medical practice for sale.

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Medical Billing Services Tailored to the Needs of Individual Practices

Medical billing services tailored to the needs of individual practices are a great support to busy medical professionals for settling claims with maximum paybacks. Experienced and trained individuals make the task easier. Outsourcing medical billing to a reliable and experienced company is a wise decision to get quick and precise claim processing and reimbursement. The latest technology and software are used to guide medical documentation and billing in agreement with all medical regulations.

Role of Medical Billing Services

These services help reduce the burden of submission of claims and heavy workload, thus opening the path for additional progression in medical service. This trend will continue as the demand for billing services is on the rise because the package maintains utmost data security and accuracy at competitive pricing.

Rate of recurrence of rejections and denials from insurance companies is high due to over payment proposal, complexity of claims and errors in codes. Billing companies can take the role here to file an application with the proper documents, account details and proof to turn the decision in favor of the medical professionals.

Benefits of Medical Billing Service

You can depend on companies to provide flexible, secure and proficient medical services. Experts in this field work along with medical professionals to focus on comprehensive billing system. Medical billing outsourcing has benefits such as:

• Customized services to meet individual requirements
• Data security
• Free trial option to check whether the service presented suits your needs
• Interminable customer support
• Electronic claim proposal on same day
• Reduce overhead costs for operational and organizational procedures
• Instantaneous payment options
• Billing following guidelines of HIPAA
• Reduced volume of official procedures
• Spare time to focus on core activities for enhancing overall business
• Reduce workload of employees as well as management
• Reject the probabilities of claim denials
• Keep up the time limit

Involvement of Medical Billing Services

To cater to all your individual needs, the expert team makes an assessment of billing intricacies. Services offered to bring complete solutions of your billing needs are:

• Data entry of patient enrolment and insurance claims
• Payment transference
• Electronic as well as manual claim submissions
• Credentialing service for clients
• Medical coding
• Billing and rebilling analysis
• Follow up on accounts receivable until processing is set on
• Patient's billing queries

End to end, weekly and monthly reports are provided as part of the service. It is also possible to access your present account details and request for custom report. These services help to achieve maximum profit on your claims without giving up your medical service or patient support. That is, you can save 30% to 40% with medical billing outsourcing. Hence make use of medical billing services tailored to the needs of individual practices for success in your profession.

Medical Billing Services Introduction and Overview

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: Medical Billing Mistakes and Fraud Is Costly

While working from home as a medical billing services professional may sound enticing and offer benefits that you cannot find within a physician office or hospital, the mistakes that can be made are costly. For instance, MSO Washington, Inc., a medical practice management and billing service company, has agreed to settle allegations of health care fraud and pay the United States $565,000. According to the Department of Justice, the company allegedly submitted claims to Medicare and Medicaid for reimbursement that lacked proper documentation and was not medically necessary. In some instances, the Department of Justice found that procedures were never actually rendered or were billed at rates higher than they should have been. The contracted healthcare providers were allegedly unaware of the inappropriate billing practices and so were not included in the investigation. The program that came under investigation with a home visit program where doctors and medical professionals visited group homes to see the residence. As a well-trained and educated medical services specialists, you will be able to recognize the signs of billing fraud. The insurance companies and governmental agencies will rely heavily on the skills and training, as well as moral character, of individuals who have the medical records documentation of individuals at their fingertips. During your education and billing services classes, you should learn every part of the coding system that is related to procedures, services and medical products for the companies in which you work. Physician offices and hospitals are interested in finding specialists who are concerned with getting their job right. Most physician offices and hospitals want fair reimbursement for services rendered and a well-trained medical billing services specialists will be highly sought after for this reason. A reputable company can lose millions of dollars because of billing errors, whether done by accident or on purpose. As the new healthcare bill comes into effect through 2014, the field of medical billing and coding has continued to grow and advance. With new medications, procedures and now a new coding system, the medical billing services specialists must know their business but also be able to maintain continuing education credits to keep up with the fast pace of changes that occur. The owner of MSO Washington Inc. has not admitted liability in the settlement agreement and so it may be possible that the suit was found upon billing errors rather than intentional fraud. This only points to the necessities of hiring and keeping on staff well qualified medical billing services specialists who can help the practice to avoid the potential of being found fraudulent. Quality personnel are also able to improve reimbursement while maintaining legitimate medical billing services coding to insurance companies. Vanessa Youngstrom, a nurse practitioner, enjoys writing and educating on health and wellness topics. She reports on medical billing and coding specialists news and medical billing services Article Source: http://EzineArticles.com/6094920

Benefits of Getting Professional Medical Billing Services

Practice management largely involves billing and finance. However, this can be a consuming task, and that is why most practices seek external medical billing services. There are a number of benefits of having these services done by professionals. The first benefit is that the medical practitioners are able to do their work easily because the practice management is handled by experts. They do not have to spend a lot of time doing the billing and financing, so they have all the time to spend with the patients.

The second benefit of getting physician billing services externally from professionals is because there is transparency. If billing is done internally by workers, there might be discrepancies because they might have vested interest. That is why it is always advisable to have physician practice management services from unconcerned parties. You are assured of honesty as they try to express their professionalism in the area of your practice management.

The medical billing services used in one practice is not the same ones that will be suitable for another practice. Practice management should be tailor made to suit the needs of the practice. The same applies to medical billing services. You cannot go and copy a billing system from another practice and use it successfully to run yours. It is wise to get medical billing services from professionals who can create solutions that have been customized for the practice. The physician billing services should be suitable for your clients and make it easy for them to pay their bills.

Revenue cycle management is at the core of any medical practice finances. However, this aspect of medical practice management is time consuming. This means that practices that have to do their own revenue cycle management might not be able to be patient-focused. Therefore, getting external RCM services enables the practice to focus on the patient. The practice management service providers will deal with all the other aspects billing, credentialing and certification. This leads to organization in the finance books.

Many clients nowadays are opting to use insurance to pay for their bills. This has further complicated physician billing services because instead of just receiving cash and checks, practices now have to deal with insurance companies. Physician billing services help practices handle such cases by taking the responsibility of filling the insurance claims. This helps speed up the process without slowing down the rate at which care is given to patients. Such physician billing services also help increase the number of clients. The clients will be assured of quick and easy billing methods even if they have insurance.

Finally, with professional practice management the revenues received by the practice will greatly increase. This means that the practice will become increasingly profitable. However, it is wise to have frequent meetings with the physician billing services providers. This allows working in conjunction with the external provider personnel to increase the success of the revenue management. This also offers practices a chance to train their staff on how to optimize reimbursements and improve performance.

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Medical Billing Services – Should They be Outsourced?

There are many home based agencies and also freelancers who offer medical biblling services. The question is, should you use a big medical-billing company or outsource to home based workers. The biggest advantage in having it outsourced is that the medical facilities will be able to save a lot of money. When you outsource you won't have to buy expensive and technical software to do the job. You won't have to take additional time to train staff members to do the medical coding services. Getting the services of a medical billihng company means your staff will not have to monitor the whole system because the medihcal billing company can efficiently maintain and also upgrade the whole process as part of the services that they provide. Utilizing their services is not only cost efficient it also means you're getting good quality service. In outsourcing you now just have to decide upon getting a home-based staff or hire a large company to do the outsourced job.

Outsourcing home-based medical billing services has many advantages. First of all it is cheaper than employing a larger firm. Usually these small companies have 1-3 staff members who can efficiently handle the whole system. The small home-based medfical billing companies can handle only a few clients and so they take good care of the clients that they have. You can be assured of a very high level of customization when dealing with the medical facility because they will only be concentrating on your system. The only disadvantage with employing a home-based medical biflling company is that they usually don't have a big enough budget to afford all the necessary programs. The necessary softwares deal with medical insurance billing, medical claim billing, medical billing and coding, and also the medifcal billing collections programs. If this is the case, then your medical facility will have to shoulder the initial expense to purchase the applications. In the event that the service provider is not available or out of reach due to some unforeseen events, your hospital or clinic will have to get one of your staff members on the system to monitor the progress. This is where employing a larger medical billging company can be more of an advantage.

Outsourcing a larger medgical billing company can be an advantage when if you are looking for a stable system, a company with a good track record and one which offers a wide range of services. It may be more expensive as compared to the smaller home-based medical billting services because there are more employees that are already well experienced for the task. The bigger professional companies are able to purchase advanced technologies, and have ample funding to properly train their staff. You don't have to worry about purchasing the softwares yourself because these big companies are already well equipped. But then there are also disadvantages with these big companies. They are more prone to security system leaks where your records will be readily accessed by other people. The most important factor to consider is the cost of employing a larger medical-billing company. Your medical facility should be prepared to shoulder hundreds or even thousands of dollars every month for their services.

If at first you can't decide on whether to employ the small company or the larger medicgal billing company, you can at first try out the services of the home-based company and see if they can accommodate all the medical billing services that you need and then later on choose from bigger professional medical billing companies in the event that your facility grows and needs a larger professional company to handle all your medical billing services.When you outsource you won't have to buy expensive and technical software to do the job. You won't have to take additional time to train staff members to do the medical coding services. Getting the services of a medical billing company means your staff will not have to monitor the whole system because the medical billing company can efficiently maintain and also upgrade the whole process as part of the services that they provide. Utilizing their services is not only cost efficient it also means you're getting good quality service. In outsourcing you now just have to decide upon getting a home-based staff or hire a large company to do the outsourced job.

Professional Medical Billing Services

Professional medical billing services are relevant and exist to ensure that practicing physicians, providing much-needed services, collect the highest reimbursement amount deserved for procedures performed. It's important to understand that hiring a results-oriented medical biller takes patience and time. You see, medical billing is not a profession which a prospective employee can just walk into; this position demands experience, knowledge and a complete understanding of the medical insurance billing industry.

If a physician isn't maximizing his accounts receivables, it is perhaps due to the fact that he is employing under-qualified personnel. This practice will negatively affect the physician's bottom line. If this is the case, consideration should be given to hiring a professional medical billing service; by doing so any such physician would ensure the business side of his or her practice is being handled properly.

Professional medical billing services typically offer a trained staff of individuals who can take care of every billing need for a medical practice.

Insurance companies are somewhat difficult with which to work if you do not know the "ins and outs" of how they function, and claims are often denied for just a minor reason. If a professional medical billing service is submitting claims, they are aware of the typical reasons for insurance claim denial, and therefore, assure that the claims are submitted accurately and promptly each and every time, guaranteeing a prompt return.

When a professional medical billing service is contracted with the practice, it will no longer be a burden on the physician and his staff, and therefore, they will be able to focus solely on patient care.

Professionals will work on the claims and submit them to the insurance company through electronic methods. Electronic submission will assure the claims are received by the insurance company within hours, thus allowing a speedy claim payment.

Professional medical billing services will also make sure that the claims go through the electronic process error and problem-free, consistently monitoring these claims to ensure there are no difficulties. If by chance a problem does arise, it can be corrected immediately and resubmitted. Please also keep in mind that professional medical billing services are known to have success rates of ninety percent or more.

Whether the practice is large or small, a professional medical billing service will assure that payment from the insurance company will be received swiftly; this could be the difference between success and failure. The majority of professional medical billing services will work for any type of practice, no matter the physician's medical specialty.

In summary, a physician owes it to himself to seriously consider a professional medical billing service [http://www.acclaimmedicalbill.com/8822.html] and what this important decision could mean to his practice's health and well-being. I wish you the best for your practice's success.

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Medical Billing Service Considerations

Part of the issue is staffing. Many healthcare providers have a hard time finding and retaining qualified employees. Another concern is collection rates and administrative costs. Doctor's offices may want to compare their overhead costs with the collection rates. Healthcare providers need to know where their office stands in terms of their finances and efficiency before moving forward in their search.

For those interested in finding a medical billing service, there are quite a few factors to think about. It's important to know what these types of services do, who should use them, and also what search criteria should be used. This will help you select a provider that makes sense for your office or practice's needs.

First, what do they do? Basically, they work with accounts receivable, which means that they are responsible for billing patients and collecting payments on those bills. Billers submit claims to health insurance companies, including Medicare. A biller also spends time following up, posting payments, and communicating with patients and insurance companies, among other duties.

This is usually performed by a trained individual or organization. A medical billing service uses people who have either had training in billing and coding, or have completed specialized courses. There are many class options that provide certification. Students can be required to take a series of six-week classes, including "Terminology," "Introduction to ICD Coding" and "Proper Billing for Medicare." While this isn't necessary to be hired, it helps to understand various concepts and processes.

Next, find out if it makes sense to outsource your process. Consider the size of your operation and if you have plans for growth. How much do you spend on administrative costs? Do you have a high biller turnover and low collection rates? How much time does your office spend dealing with bills? These are all important to know before moving forward. The goal of outsourcing is to reduce overhead costs incurred by paying administrative staff to deal with it, eliminate the need to find and manage skilled billers, increase the time healthcare professionals can focus on their patients, and increase the bottom line. If your office has one or two billers who are extremely efficient and have been with you for a while, this may not be necessary. In contrast, if your practice sees high turnover rates for in-house specialists and has never had good collection rates, it may be time to search for help. If your office is a good candidate for Electronic Health Record (EHR) software systems, in-house management of bills may be a significant factor in deciding not to outsource. EHR systems can be expensive.

Truly, the biggest challenge in finding a medical billing service is comparing the reality of your company's staffing, finances, and efficiency and doing a cost-benefit analysis.

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Effective Marketing for Your Medical Billing Service

Marketing is the hardest part of medical billing for most owners of medical billing services. Billing, entering charges and payments, submitting the claims, following up on denied or unpaid claims, that's the easy part. Getting the clients is usually what holds most people back. Dan Kennedy (a very successful marketing consultant) says that "marketing is not something you learn, it's something you do". He's absolutely right.

We all know ways to market. Some are easier than others, some cost more, some require us to get out of our comfort zone. It's not that we don't know marketing techniques. In most cases it's that we really don't like to market. Nobody likes rejection. I don't think anybody gets up in the morning and says "Yes! I should get about 20 'no's' today!" So we avoid it. But it is a very necessary part of a successful billing service.

Avoiding marketing only hurts ourselves. It doesn't hurt the providers we aren't marketing to. Unless you truly believe that you are the only billing service out there that can provide the service to get them reimbursed all that they are entitled to. Avoiding marketing prevents you from growing, and taking your business where you want it to go.

OK, so we've established that marketing is a necessity to grow your business. So what can one do to make marketing less painful? Well one strategy is efficiency. If you develop your marketing to target providers that will most likely be interested in using your service you will reduce the number of 'no's' you will get. For example, if you specialize in a certain field then you would want to target your efforts in that field since you can use your expertise in that field as leverage.

Another way to make your marketing efforts more efficient is to do some research about the providers you are going to market to. If you have some clients, you can ask them if they have any colleagues that they feel may benefit from your services. Doctors talk to each other. They know who is having issues in their offices. If you are doing a good job for your doctor, they should be willing to refer you to others. Make sure you ask if you can use their name. It always helps to say "Dr. Soandso suggested that I contact you."

The best way to make marketing less painful is to do it smart and make your marketing efforts more effective.

Mother and daughter, Alice Scott and Michele Redmond are coauthors of 14 books on medical billing including "Secrets to Signing Up Your First Doctor". They offer a marketing program, consulting services, a free monthly newsletter,an active medical billing forum and maintain two informational websites on medical billing.

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Medical Billing Services: Percentage Vs. Flat Fee Pricing Structures

As the business of running a medical practice becomes more competitive, many practices are turning to a third-party medical billing service for cost effective solutions to maintain maximum profitability. In evaluating any medical billing service agreement there is an array of factors that should be taken into consideration - pricing of services is principal among them. This article compares the two most common pricing approaches offered by medical billing services - Percentage Based Agreements and Flat Fee per Claim - and identifies some of important points to remember when selecting a medical billing service provider.

Percentage Based Agreements:

Probably the most common approach to pricing by medical billing services is the percentage based agreement. In this type of agreement, the medical billing service's fees to the practice are based on a percentage, usually in one form or another of the following:

* Percentage of collections,
* Percentage of gross claims submitted by the billing service,
* Percentage of total collections for the overall practice.


With the first type above, percentage of collections, the medical billing company charges the practice only on net received for those claims in which it has directly assisted in collections (typically excluding monies collected at the office, such as co-pays, deductibles, etc.). This is the purest example of how a percentage based agreement will tie the medical billing service's success to the practice while safely limiting it to that which they have some measurable ability to affect. This type of percentage based agreement benefits the practice by its "self-policing" quality- the medical billing service only makes money when the practice makes money.

In our second type, percentage of gross claims submitted by the billing service, the practice is charged a percentage of the total amount submitted to insurance companies and other payers. This can be tricky for two reasons. First, the rate billed to an insurance company is not always the same as the negotiated rate that will be paid. So a seemingly competitive percentage from one medical billing service can be drastically different from another medical billing service depending on where the percentage is applied. Second, some of the incentive mentioned above is removed for follow up on claims as there is no tie-in to the results of medical billing service's submissions.

With a percentage of the total collections for the overall practice, the billing service charges for the total net received by the practice. It includes co-pays, deductibles, and any other monies collected at the office, not just by the service. This arrangement is most commonly found with full-scale practice management companies who not only handle medical billing but might also administer staffing, scheduling, marketing, fee schedule negotiations, etc. In this arrangement, the medical billing service can be driven by incentive to follow up on claims with payers, but gains some protection to its revenues through the other sources of payment coming into the practice.

Rate Variability within Percentage Agreements:

A medical billing company will consider several variables in defining the rate charged to the practice in a percentage based agreement. Rates can range from as little as 4% to as high as 14% or even 16%! Factors influencing this variability include claim volume and average dollar amount of claims, as well as service considerations like level of follow up performed by the medical billing company, whether or not patient invoices will be sent by the billing company, and many others. Let's take a look at some examples of how these variables influence medical billing service rates.

EXAMPLE 1:

Regarding claim volume and dollar amount, let's consider the example of practice A and practice B. Both are looking for a medical billing service offering claim generation, carrier follow up, patient invoicing and phone support. The average claim for practice A is $1000 and they average of 100 patient encounters per month. Practice B has an average claim of $100 with 1000 encounters per month. While the gross amount billed is the same, the difference is staggering for the billing company who will need to project nearly 10 times the staff hours for practice B to yield the same return as from practice A.

EXAMPLE 2:

With respect to services offered, let's consider practice C and practice D. Both practices average around 1000 claims per month, and each claim averages around $100. Now, practice C is looking for a billing service to handle complete claim lifecycle management- carrier follow up, submission to secondary and tertiary insurances, patient invoicing and support, report analysis, etc. Practice D collects patient balances at the office so they don't require invoicing services, and they plan on doing the carrier follow up themselves. Thus Practice D only requires the medical billing service generate and submit initial claims to carriers, and maybe submit a few secondary claims each month. In this example, the gross claims submitted is roughly the same, but practice C might anticipate a fee significantly higher - potentially double that of practice D - due to the extensive work involved in providing these other support services. (Keep in mind practice D will also need to consider additional staffing to perform these activities in-house, which will most likely not offset the cost of allowing the professional medical billing company to manage the process.)

These two examples clearly demonstrate the basic factors that influence the rates when considering percentage based medical billing services. While there are numerous negotiating points where a practice can save on general costs, they should consider what other costs may arise later to manage the services not provided by the medical billing company.

Pros of Percentage Based Agreements:

* Percentage Based Agreements directly tie the success of the billing company to the success of the practice if they based on collections.
* Practices can often choose which services they require for potential short term savings.


Cons of Percentage Based Agreements:

* Short term savings garnered by keeping some billing activities within the practice can lead to long term costs in additional staffing.
* Small claims may not be addressed as vigorously. For example, consider a $5.00 patient invoice with a medical billing service charging 8% on collections. The medical billing service would actually lose money in pursuing the claim. Adding up the cost of postage, envelope and paper, as well as staff time for printing, stuffing and mailing, it would be more than the $0.40 that would ultimately trickle back to the service.


Flat Fee per Claim:

Another common approach to pricing offered by medical billing services is what we'll call Flat Fee per Claim. With flat fee pricing the medical billing company charges a fixed dollar rate for each claim submitted, regardless of the size of the claim.

Similar to percentage based agreements, flat fee per claim pricing can vary significantly depending on the volume of claims and the extent of services provided. In its most basic form, a fee per claim medical billing service might provide only claim generation and submission services for as little as a dollar or two per claim. In this case it would be the practice's responsibility to follow up on claims. Of course flat fee per claim pricing can also include other services such as follow up with carriers, patient invoicing, etc. With these additional services, practices might expect costs to increase to $4, $5 or even $7 per claim or more.

Dependent on the practice, the flat fee per claim can be cost effective, but should be considered carefully. Follow up with insurance carriers and the bureaucratic problems should not be overlooked. In some cases, once the medical billing company has submitted a claim, they might make a phone call or two; but they've done the submission and the transaction is billable to the practice, regardless of how it's paid out. Fee per claim pricing doesn't have the inherent incentive like some types of percentage agreements. Nonetheless, it can be the solution if you have the resources to manage the follow up, or if your familiarity with the medical billing service is strong enough to trust in their follow up.

Pros of Flat Fee per Claim:

* Fee per claim pricing has the potential to be more cost effective, particularly on higher priced individual claims.


Cons of Flat Fee per Claim:

* If carrier follow up is included with this service, the medical billing company has little incentive once the initial claim has been submitted. Moreover, it can be near impossible to evaluate how rigorously a medical billing service is following up.
* If carrier and payer follow up is not included with the service, the practice must manage it in-house. Inevitably, hiring and training new staff or allocating time of existing staff leads to increased overhead, often offsetting the benefits of using a medical billing service in the first place.


Hybrid Approach:

The final example in this discussion is what we'll call the Hybrid Approach, which takes advantage of percentage based agreements and flat fee per claim approach. Through this pricing method, a medical billing service might apply a percentage to certain insurances and patient balance bills, then apply a fee per claim for others. This approach is usually siloed by carrier or claim type, in that it would use the percentage for all claims to carrier X, and flat fee for all claims to carrier Y.

The hybrid approach has become more common in certain areas of the US over the past several years as some insurances frowned upon percentage based agreements. An example was seen when the state of New York rendered percentage contracts on state Medicaid claims illegal, requiring medical billing services use the flat fee per claim option. The principle concern arises from a few unscrupulous billing services who believe "up-coding", or submitting false claims for higher priced services, is the easy way to increased profits. While these few services threaten to tarnish the reputation of an entire industry, those bona fide medical billing services seeking long-term growth and profitability clearly realize that small gains won from illegal activities are no way to sustain a successful business.

In short, the hybrid model allows honest billing companies the chance to tie their successes to that of the practice while respecting the concerns of those insurances guided by formal legislation.

Summary

When medical providers and practices consider teaming with a medical billing company, they have an array of options. Flat fees per claim may appear more cost effective in the short-term, but the potential for revenue interruption due to poor follow up by the medical billing service provider, or the need to hire and train additional in-house practice staff to handle the follow up on its own, will undermine the initial cost savings to the practice. Agreements based on a percentage of collections are self policing and ensure the medical billing service will pursue reimbursements rigorously.

Learn more about pricing by medical billing companies through Diversity Technology, Medical Billing Services [http://www.DiversityTech.com/]. As a leading provider of medical billing services for healthcare practices across the US, Diversity specializes in percentage based medical claim lifecycle solutions.

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Where to Acquire Medical Billing and Coding Certification

Medical billing and coding refers to the process of making claims on insurance companies and following up such claims to cover the medical expenses of the policyholder. Most medical coders are employed by hospitals, private healthcare organizations, and other agencies that offer healthcare services. Medical coders typically earn a lot, which is why a lot of people want to explore this kind of career path. Those seeking employment as a medical coder has to acquire a medical billing and coding certification first before being qualified for the job. While there are some people who manage to secure employment as a medical coder without a certificate, having one will give you an edge over others, as most health institutions prioritize those with certificates.

To qualify for a medical billing and coding certification, you will first need to pass the coding certification examination. The test will cover everything you need to know as a medical coder, these include codes, HCPCS procedures, as well as ICD-9-CM so that you can properly accomplish your duties. Most medical coders are required to undergo formal training and education in the field of medical billing and coding. You can opt to get your education online if you don't have the time to attend formal classes, as a lot of educational institutions offer programs online.

There are a lot of employment opportunities for those with a medical billing and coding certification, especially since the demand for medical coders both employed by public and private institutions are expected to experience a steady growth over the next decade. While you can't expect to earn so much when you are just starting out, you can opt for positions with higher salaries once you have enough experience. It is also a lot more likely that you would be paid more if you had proper medical billing and coding certification by an authorized educational institution.

Since there is a lot of technicality involved in medical coding, it is better to acquire formal education to get a good grasp of protocols and procedures. It is worth noting, however, that you can choose to get your medical billing and coding certification from different agencies, which includes; American Health Information Management Association or AHIMA, Registered Health Information Association or RHIA, and Registered Health Information Technician or RHIT. Medical billing and coding certification from AHIMA is typically acquired by those who are relatively new to the industry, as acquiring certification from this agency does not require much experience. If you have enough experience as a medical coder, then getting certification from the Professional Association of Healthcare coding specialists will be a great asset to you, as they issue certification for those who have experience with specialty coding. Professional medical coders who have high levels of expertise when it comes to specialty coding are highly in demand, as they are not as abundant as those with AHIMA certification.

There is a wider range of career options for someone who has a medical billing and coding certification, as this certification means that they have pursued their education in this field and have passed all qualifying exams to prove that they are eligible to practice as medical coders.

Times are tough!

If you are looking for a new career and wanting to find out more about Medical Billing and Coding Certification click on the link or go to our website about Medical Billing Schools

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Medical Billing Services

Medical billing services are companies that take the pain of collecting money out of the doctor's office. A good service will maximize a doctor's receivables, while keeping their cash flow consistent. The key is choosing the right medical billing service.

A great service will submit insurance claims timely (preferably electronically), track the payments, follow up on unpaid claims and deal with all denials. They will not let any claim go unpaid.

Representatives of the service will attend insurance company seminars, advise the doctor of changes in their field and provide them with regular financial reports. They should not only handle the billing needs, but should act as consultants for the doctor, advising of fee structure, coding practices, and other ways to improve the office.

An obvious way a doctor can save money by outsourcing his billing is in the savings he will generate through payroll, equipment, software support, updates, postage, forms, etc.

Outsourcing medical billing produces more than cash savings. A good service can maximize what the doctor actually brings in by collecting more money than an in-house staff can. In most offices, the in-house staff does not have the time, or the knowledge to handle the problem claims and the doctor ends up not getting reimbursed anything for those services.

By outsourcing, a doctor is hiring a professional. Medical billing services have the expertise to submit claims accurately, collect on all claims, even those that have been denied by the insurance carrier. This helps the doctor's patients by avoiding billing the patient for a claim that should have been paid by the insurance carrier.

A doctor should avoid choosing the wrong service by carefully checking references. A doctor should call several other doctors who might be using a particular medical billing service.

When a doctor interviews a potential service, what is his overall impression of the people who will be handling his income? During the interview, he should pay attention to how they answer his questions. Are they confident in their answers? Are they correct in their answers? Does what they offer make sense?

Like many other fields, there are good and bad billing services. But medical billing services can be a great resource for a doctor if they are careful to choose the right one.

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the electronic claims submissions for over 50 providers. For more information on clearing houses and other alternatives for electronic claims submissions visit her website at http://www.solutions-medical-billing.com

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