Medical billing service providers come in many different shapes and sizes. At one end of the spectrum are large practice management companies, with an extensive network of support but sometimes rigid and expensive. At the other end small, home-based businesses. With more programs offered through local colleges, mail orders and online, home-based businesses are popping up everywhere.
Somewhere in the middle of these two extremes is what we will refer to as Professional Medical Billing Services. When considering your options, it is important to understand what each type of medical billing service provider has to offer and which is best for you. This article discusses the common types of medical billing service providers and some of the services they offer Medical Condition.
Home-Based Medical Billing Businesses vary significantly from one to the next in experience, ability and services offered. Many are small start-up businesses with only one or two employees. Some offer extensive experience from the doctor’s office, others may have only one or two clients. While these service providers can offer the highest levels of customization, a small, home-based business can sometimes run short of knowledge management and business information to be there for the long term. And what happens to cash flow when the solo biller decides to take vacation? Most provide the core services of medical billing (discussed later) and many have other personal experience to offer ancillary services.
Practice Management Companies that are typically larger firms that may have 100 or more employees. Most true practice management companies take a holistic approach to supporting your practice, so they can handle all the facets of managing the business – including medical billing, marketing, staffing, and even patient scheduling. Although some providers might be excited about having a practice management company take all the “trouble” off their hands, others found it to have someone else running their business. While they are interested in working with a practice management company, they should be willing to agree with agreements and contracts to make sure they know exactly how their practices will be “managed.”
The Professional Medical Billing Services fall in between the extremes of home-based medical billing and the practice of management companies, leveraging the strengths of both and eliminating the weaknesses. With a few dozen employees, Professional Medical Billing Services can offer greater flexibility than a practice management company, but more than the home-based service structure. They have a sustained network of support to eliminate interruptions to cash flow from vacations or unexpected leave times, while offering personalized services tailored to meet their needs.
As you are of the type of medical billing company, it is also important to think about what services you will need to handle in-house, and what expectations you have for your medical billing professionals. Each of the types mentioned above should be able to offer the following standard services; though service delivery, flexibility and customization can vary widely.
Standard Medical Billing Services
Standard services offered by medical billing companies are discussed above. There are some services that are provided. Again, experience and size play a key role defining where the variations might be. Regardless, the following list identifies the most basic services provided by any well organized medical billing company.
Claim Generation and Submission Claim generation includes the entry of patient demographic, insurance and encounter information into medical billing software. Claim submission is the process of sending data to the carrier, either electronically through a clearinghouse, or via paper submission in the mail. With electronic medical billing, services should apply to one or more “scrubbers” to claims (and manual quality checks to paper claims). Scrubbers are quality assurance checks of diagnosis and procedural codes for errors typically integrated into premium medical billing software programs.
Carrier Follow Up Carrier follow-up is an integral part of the medical billing industry – arguably the most important aspect. The quality of a medical billing service is often defined by the level of follow-up. Through follow-up, medical billing companies are able to isolate those claims that may be unpaid, or partially paid, and work with the provider and carrier to make sure edits and resubmission are clean.