Medical billing outsourcing has been growing at a rapid pace over the years, and based on a report by Grand View Research, market size is projected to reach $19.7 billion globally by 2026. The chances are that you’re reading this because you are considering outsourcing your medical billing. If so, here are some key considerations to keep in mind when choosing a billing service provider.
Medical Billing Costs
When looking into selecting a medical billing company to work with, there are several things you need to ask before deciding who you will choose. One of the most important (and obvious) key considerations is the cost.
Cost is important for a few reasons. First, the pricing model can vary. The billing service might charge a percentage of net collections and have a floor rate in the case that your collections don’t exceed a certain amount. Another common option is a flat fee in which regardless of collections, the billing service is paid the same flat fee per claim or base rate.
With the flat fee pricing, the medical billing company charges a fixed rate for each claim submitted or static monthly fee, regardless of the size of the claims. Depending on the medical practice, this model can be cost-effective but should be considered carefully. The fee per claim pricing model does not offer the incentives for the billing company like the percentage of overall billing collections agreements.
Second, you need to make sure the medical billing companies you’re considering are within your budget. However, you don’t want to stop at just the budget. It is typical for a cheaper billing service to exclude many of the billing functions practices wish to outsource. This leads me to the next key consideration when choosing a medical billing service: what exactly is included.
What is included?
It doesn't take much research to know that not all medical billing services are created equal. There are several differentiators when it comes to medical billing vendors, so how do you go about comparing each service?
Start with what is included. Gather an exhaustive list of every piece of the revenue cycle management process and compare billing services to this list. This list is not the only piece of the puzzle, but it can help you understand which service will be a better fit for your practice.
For example, some practices might prefer to keep the denial management in-house and outsource the rest of the medical billing process. This co-sourcing arrangement is not always the case. Still, it’s essential to understand which parts of the process your practice will continue to be responsible for depending on each medical billing vendor. Here are a few pieces of the revenue cycle management to consider:
- Insurance Eligibility
- Medical Coding Review
- Claim Submission
- Patient Statement Services
- Payment Posting
- Accounts Receivable Follow Up
- Refunds and Overpayments
- Denial Management
- Reporting and Analytics
How will the medical billing company handle denied, rejected, or unpaid claims?
When it comes to medical billing, preventing and managing denials is a crucial process because denials continue to be a major challenge for healthcare. Underpaid, rejected or denied claims can cost your practice as much as $100,000 per month, according to the American Medical Association.
Asking questions like:
- What is your company’s average denial rate?
- How do you identify and correct claim errors?
- How does your solution proactively address denials management?
- What types of reports are provided to measure the effectiveness of the denials management process?
- What steps does your company take to prevent denials and rejections?
Is training provided?
Providing training services is relatively new for medical billing services. A majority of medical billing vendors are eager to gain access to claims and start seeing payments. This can be a good thing, but without proper training, you can encounter long term issues that threaten revenue cycle results.
High deductible health plans are common, and deductibles continue to grow, which means your front office staff needs to be well versed in best practices when it comes to communicating insurances to patients and collecting co-pays. Front office staff should be adequately trained on how to explain insurance plans and patient statements as well as how to ask, "how will you be paying today" and not "would you like to pay today." Your front office also needs to be well versed in explaining your financial policy and the payment options available to increase patient payments.
In addition to communicating insurances, collecting co-pays, co-insurance, deductibles, and out-of-pocket costs, the front office is also responsible for verifying patient demographics. Demographic errors are one of the top reasons insurance claims are rejected. Having the medical billing service provide the level of training necessary for your front office can ensure that best practices are applied at the front office, and accountability is maintained for the length of the billing agreement.
Several questions should be addressed during the process of researching and selecting a medical billing service. At Revele, we encourage detailed discussions regarding your medical billing process and are committed to being completely transparent with your practice from day one.
Talk with a consultant today to learn more about our end-to-end medical billing services or download our request for proposal template for a more detailed list of questions to ask during your search for a medical billing service.
Revenue Cycle RFP Template
Get access to over 50 questions to ask medical billing vendors during the request for proposal process.