How to Choose a Medical Billing Service for Your Practice - BillingParadise

2. Outsourcing Outsourcing your claims to athird party medical billing service can make or break your healthcare organization. It’s important to choose your billing provider carefully, and that’s what I am here to explain you how to do today.

3. 17Checklist you should consider when choosing a Medical Billing Company

4. 1. AAPC certified Coders • 3 reasons why you must double click on certified coders: • AAPC/AHIMA certified medical coders offer coding specificity. • Clinical documentation improvement forms the fulcrum of current healthcare regulations. • Certified coders usually specialize in one particular specialty. This specialty specific expertise translates to increased coding efficiency.

5. 2. EHRFocusedbillers • Before hiring a medical biller/ billing company make sure your EHR doesn’t flummox them. • Benefits: • Quicker claims cycle &elimination of double work • Better ROI on EHR • Tightly aligned processes

6. 3. Federal government compliance • Verify whether the medical company you opt to work with is in compliance with federal norms. Data security promises must be combed through carefully. • Benefits: • Minimized risk of data security leaks. • Assured compliance with federal guidelines. • Some companies also offer MIPS, MACRA support.  

7. 4. Technology – IT matters • To improve revenue outcomes over the long run, working with a RCM company who has technology expertise to integrate patient billing, denial management, AR management, and put together the fragmented pieces of your revenue cycle. • Benefits: • Automation speeds up processes and cuts costs • By working with a technology enabled RCM Company you can keep up with changing times

8. 5. It all boils down to money • A survey by Peer60 states that 83% of hospital executives surveyed shared that cost was the major criterion in the revenue cycle vendor decision making process. • Benefits: • Different pricing options give you the power of choice   • Fixed prices eliminate guesswork

9. 6. Tech enabled AR Management • Adopting an AR management software drives down the cost of receivable management. • Work with medical billing organizations who offer AR automation support. • Benefits: • AR processes are streamlined and accelerated. • An AR system offers value rich intelligence. • Weeds out AR follow-up inconsistencies.

10. 7. Automate Denial Management • Around two thirds of denials are recoverable and 90% of denials are preventable. Look for a vendor who offers a denial prevention and reporting system. • Benefits: • Long-standing issues with denials get resolved with automation. • Denial patterns are easily brought to the surface.

11. 8. Patient experiences • Referrals are playing a huge role in bringing new patients to a medical practice. • Unfortunately, according to recent studies 70% of referrals go unscheduled due to interminable waiting times. Work with a company that offers patient access management.    • Benefits: • Better patient experiences result in retention and positive provider-patient relationships. • Improved front-desk revenue capture.

12. 9. Expand your horizons • Most successful healthcare organizations are focusing on expanding their practices to handle the high volume of patients. • The medical billing company you work with should provide the ideal foil to your expansion plans.   • Benefits: • Centralized medical billing and revenue cycle management processes. • The headache of paying multiple vendors is eliminated.

13. 10. Provider enrollment • It is vital to work with a RCM provider who has a revenue centric approach towards provider enrollment. • If you can have a dedicated team to handle the credentialing and provider enrollment process, it is half the battle won. • Benefits: • Enhanced revenue cycle performance under risk based contracts • Quicker credentialing and provider enrollment processes

14. 11. Strong Contracts = more revenue • Payer contracts inform and drive a healthcare organization’s day to day business. Your RCM Company should offer advanced contract management solutions and risk mitigation support as your medical practice transitions towards newer payment models. • Benefits: • Strong contracts that improve yield. • Protection against “evergreen” contracts.

15. 12. Transition support • A proper transition plan should include a single contact person, a complete audit of your current revenue cycle, training for in-house staff and appropriation of responsibilities between your employees and the billing company. • Benefits: • Avoid temporary revenue loss and fluctuations during the transition phase. • Help in-house team to acclimatize to a new working environment.

16. 13. LRRA (Lost Revenue Recovery Audit) • List out your problem areas and ask your billing company to propose solutions in handling similar bottlenecks solutions. • There are several RCM companies that offer a thorough Lost Revenue Recovery Audit to identify fissures in your revenue cycle. • Ask for reports like: • Claim rejection report • AR report • Reimbursement velocity report

17. 14. State laws - Comply or die trying • The billing regulations for physician assistants (PA) in each State differ vastly. It is important to analyze the context for PA practice within your State’s billing laws. • Benefits: • Avoid non-compliance threats and penalties • Stay on top of billing regulations

18. 15. Specialty specific billing • Not working with a medical billing company who are not well-versed in billing for your specialty means you are going to leave enormous amounts of money on the table. • Benefits: • Avoid revenue risks and medical coding errors. • Specialty-focused services help you capture more revenue as the intricacies of billing for your field is well understood.

19. 16. Payers specific • To gain maximum reimbursement medical billers should have intrinsic knowledge of the payment mechanisms of the insurance companies they work with. • Benefits: • An understanding of payer mechanisms quickens contract cycles. • There is more scope to negotiate favorable rates. • Denials can be handled more efficiently if the biller is well-versed with the appeals process.

20. 17. Medical billing reports • Check whether your medical billing vendor offers a solution that will help you track their performance.  • They must offer a solution that serves as a platform to communicate with your staff to avoid miscommunication. • Benefits: • Big picture insights drive stronger decisions • More transparency

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