Using a medical billing company may provide effective and efficient claim submission but is there any value to outsourcing medical billing services.

Full-service medical billing companies provide a myriad of services to maximize insurance and patient collections, allowing practitioners to focus on patient care and practice growth.

Many medical billing companies near me provide web-based solutions that include revenue cycle management from start to finish.

The process includes:

• Claims Processing – This includes entering patient demographics, insurance information, ensuring a prior authorization was obtained and on file, submitting claims electronically, filing secondary follow-up claims, and coordinating automatic crossovers.

• Patient Billing – Mailing out patient statements, responding to account inquiries, answering patient questions, and mailing out client-approved collection letters.

• Payment Posting – Entering payments and adjustments from insurance companies' explanation of benefits (EOBs) and posting patient copays

• Financial Reports – Providing access to financial reports regarding the practice's financial health. Reports include insurance aging, patient aging, monthly, weekly, and daily, summaries, and payers' reimbursement analysis

• Follow-up and Appeals – Calling insurers to check on the payment status of unpaid claims, refiling corrected claims, and filing appeals

• Online Access to Data – Practitioners can check on the status of unpaid claims, review balances, and run financial reports 24 hours a day, 7 days a week.

• Verification of Benefits – Calling insurance companies to verify health benefits and eligibility before the patient is seen. During the call, the service will confirm copay amounts, deductibles, the maximum number of visits allowed, authorization requirements, and claims mailing address.

• Clarify the Collections Process Upfront – Open, transparent communications with patients are essential. It is vital to inform patients about their financial obligations. Many practices post a sign detailing copay collection and unpaid bill policies in their reception areas.

• Practice Management Solutions – Some offer time and money-saving solutions like online appointment calendars, credit card processing, online payment portals, along with appointment reminder calls and text messages.

Even with all of these service offerings, some might ask if there really is value-added when contracting with a medical billing company.

The short answer is yes. There is value to outsourcing medical billing services. But how can we be so sure? Why take our word for it?

The following case studies demonstrate the value-added.

The situation included a customer who wanted to outsource their patient's charge entry and patient demographic functions. 

The billing services goals were to:

• Ensure a smooth transition with the least amount of practice disruption

• Reduce the claim error rate from 4% to 2%

• Maintain productivity levels after outsourcing

• Train their team on the clients existing software and methodologies

• Work closely with the in-house billing team

Results:

• By the second month in operation, 150 processed claims resulted in an error rate below 2%

• The satisfied client decided to outsource their entire medical billing process, including insurance calling, charge entry, patient demographics, patient calling, and payment posting.

A potential client handled their own revenue cycle management process in-house, but after a few months in business, they discovered collections were not meeting expectations. 

As a matter of fact, for the first six months, their goal of $150,000 fell short, and they generated only about $65,000.

The medical billing service identified major claim denial issues that included:

• Credentialing problems – Credentialing was incomplete for several payers. They believed that their in-house staff completed credentialing.

• Inadequate Eligibility and Benefit Checks – The patient's demographics and insurance information were entered incorrectly, or the staff never verified coverage or benefits with the payers.

• Coding Issues – Several claims were filed incorrectly using old, inaccurate billing and coding guidelines. For example, the inexperienced staff used CPT codes which were discontinued and replaced.

• Filing issues – The in-house staff fell behind and failed to bill out claims on time because they were inundated with billing function issues and patient inquiries.

The practice struggled with resolving the crisis of catching up while managing patients simultaneously. They decided to reach out to a medical billing company near me.

The medical billing service met the revenue goal of $150,000 within the first six months and raised revenues to $170,000 for several months thereafter. 

They also helped reduce Accounts Receivable (AR) days from 90 – 120 down to under 30 days.

These are just two of many case studies proving that contracting with a medical billing company reduces errors, increases revenues, and lowers AR days improving cash flow.

We believe this proves beyond any doubt that there is value added when contracting a medical billing services company near me.