Medical Billing and Coding Companies

A Practice’s financial existence is dependent on a Medical Billing and Coding Companies competence. Observations of a medical billing and coding service business owner. What to look for when selecting medical billing and coding companies.

Reimbursement for a provider’s service is critical to the health of the practice. There’s a perception of the general public that most physicians are making a lot more money than they do. They don’t realize the expenses it takes to run a practice (small or large) – from payroll to liability insurance, rent, supplies, etc. – the list goes on.

Vital to Financial Health
That’s why it’s so important for a practice to hire competent and committed medical billing and coding companies when outsourcing. The practices financial existence is in their hands. I’ve heard too many horror stories of billing services convincing a practice to use there services, only to find out they had little or no knowledge or experience about billing and coding.

This is after a provider has gone months without any reimbursement. We’ve been able to increase revenues over 30% just by following good fundamental billing practices when taking over a practice billing services.

Range of Services
Medical billing companies can offer a complete range of services – anything from simple claim filing to full service coding and billing. Our billing service provides the full spectrum of services from full service starting with coding and billing to simple electronic claim submission, depending on the practices needs.

Full service medical billing and coding companies typically offer the following:

  • Code claims from provider dictation
  • Enter patient visit information including ICD-9 and CPT codes in practice management software
  • Send claims electronically to clearinghouse
  • Follow-up and correct unpaid claims – The longer claims go unpaid, the harder it is to collect payment
  • Post payments received from insurance carriers and patients
  • Send patient statements out monthly
  • Coordinate delinquent patient accounts with collection agency
  • Submit paper claims (for carriers who don’t accept electronic)
  • Provide regular reports on financial performance of practice

Medical billing and coding companies should provide quick turnaround. Our company strives to have claims filed within 48 hours of receiving dictation or superbills from our provider. It’s also important a company’s operating practices are in compliance with HIPAA requirements to protect patient privacy.

In our case when a provider wants us to provide coding in addition to billing, we like to take a graded approach. We get all the billing processes set-up, transitioned, and working smoothly first. We can then relieve the practice of coding. This makes for a smooth transition with minimal impact to reimbursement.

Practice Management System
Medical billing and coding companies usually use their own practice management or billing software. Depending on our client we may use their software and server or our own server based software. We have had clients invest heavily in a practice management system (software and hardware) and not want to go through the transition to a system they don’t own or control.

Many medical billing and coding companies are turning to web based practice management applications that allow access from any location. This has its own advantages and disadvantages – chief of which is not having to maintain a server and the associated software. A lot of providers also want to be able to access the software and run their own reports and view status of their practice at their own discretion.

The disadvantage of this is the physicians office has total control of the practice management system. This certainly makes it easier if the doctor wants to change medical billing and coding companies. They just disable the users accounts and you have no access to the system.

In this case it’s important for the medical billing business owner to protect their interests and periodically run reports documenting their work. And also include provisions in the billing services contract to protect the billing service if this happens. The client must understand that they are still obligated to pay the medical billing service business for all the work they have done – and to provide reports and documentation to support it.

The advantage is the medical billing and coding companies do have the expense of maintaining the software or server. If something goes wrong, the physicians office is responsible for getting the necessary software and hardware support and paying for it.

Many smaller practices benefit from outsourcing their billing and/or coding to a medical billing service business. Most providers don’t have the staff and resources for someone to be dedicated to the billing and coding. So it’s more beneficial to outsource to a company who specializes in these tasks and is more efficient and motivated.

Fee Structure
Many medical billing and coding companies charge a fee structure based on a percentage of collected monies. This offers incentive for making sure claims are accurate when submitted and provides motivation for follow up of unpaid claims. medical billing and coding companies can charge for their services in a variety of ways – percentage, per claim, or hourly. This is specified in the contract you sign with your service:

Percentage involves charging based on the monthly revenue collected. The percentage charged depends on what services are performed, location, competition, and type of practice. A practice the sees fewer patients but averages a higher charge per visit may warrant a lower percentage than a family practice who sees several patients daily at a lower cost per visit. If coding services are provided, the expected percentage would be higher due to the additional time and resources necessary.It’s important to make sure percentage based billing is legal in your state as some states prohibit this. For special projects like aging a higher percentage is justified as this is a very time consuming and labor intensive effort.

Per Claim
Per claim charges are more suitable when a biller is only submitting claims with no other services. Some clients who don’t have the time or ability to file claims may request this service.

Per Hour
Charging per hour may be more appropriate when percentage or per claim charges are not feasible.This is usually a better option for clients who don’t see a lot of patients and charging per claim or percentage would not be worth your effort. I have charged per for special projects when charging per claim was just not worth it or performing more of a consulting role. I started out charging hourly for what is now one of my largest clients so you may consider this a way to get your foot in the door.