The revenue cycle management (RCM) process comprises many complex components – from patient scheduling and registration and insurance verification to medical billing and coding and claim submission. Dealing with these tasks along with patient care delivery is not easy for medical practices and many are choosing to outsource RCM tasks. An experienced medical billing and coding company can help practices navigate their way through the challenges of complex billing and coding requirements, payer rules and evolving regulatory requirements. Partnering with a professional, HIPAA compliant medical billing and coding company can help physicians and their staff to focus on care and improving the patient experience. Today, outsourcing medical billing is proving the best option for physician offices, family practices, clinics, and hospitals to manage their billing and coding tasks.

Medical billing outsourcing provides diverse benefits for practices such as –

  • Providers and front office staff get more time to focus on patients
  • Increased cash flow
  • Billing compliance
  • Reduced risk of billing and coding errors
  • Appropriate and timely reimbursement
  • Increase patient satisfaction

According to a Grand View Research report, the global medical billing outsourcing market size which was valued at USD 10.2 billion in 2020 is expected to expand at a compound annual growth rate (CAGR) of 12.66% from 2021 to 2028. Key factors driving the market include the increasing usage of billing and medical coding procedures in revenue cycle management and frequent revisions in the classification systems for medical coding. The front-end component of RCM consists of patient scheduling and registration, insurance eligibility verification and pre-authorization services. Back-end RCM components comprise medical coding and billing which covers charge posting, claim review and submission, payment posting, AR (accounts receivable) management and collections.

Key factors to look into for a medical billing company

Consider experience in your speciality

Consider the company’s experience, especially in medical billing for your speciality. Different specialities come with their own unique billing and coding challenges. Make sure the team can meet the claim submission requirements of your speciality. Check customer testimonials on the company’s website.

Availability of expert resources

Make sure that the company’s team includes billing and coding specialists who are AHIMA or AAPC certified. They need to be familiar with the coding and billing rules, terminologies and all conditions, diagnosis and treatment procedures related to your speciality.

Billing and coding training

Make sure the company provides regular training for their staff. The team must have good knowledge about current ICD, CPT, HCPCS and CDT coding and be up-to-date on industry guidelines and regulations.

Look for comprehensive medical billing services

Choose a medical billing company that will handle all aspects of revenue cycle management — from patient appointment scheduling to claims submission, collections, and AR follow-up. Also, find out how quickly they will begin processing claims.

HIPAA compliance

Patient data security is a major concern for any healthcare practice. And so, make sure that the company you are partnering with is HIPAA compliant. This is important to ensure the confidentiality of sensitive patient data and prevent personal health information (PHI) from getting into the wrong hands. Enquire about the company’s data security policies and the processes they use to make sure your information is protected.

Assess cost before signing up

Make sure you know how the billing company charges for its services. Evaluate their budget and ensure there are no hidden fees before you sign up.

Check how insurance verification is performed

The company should have an experienced team of dedicated insurance verification specialists with excellent skills in verifying patient eligibility for all specialities. The team must be able to confirm insurance eligibility ahead of the patient visit.

Denial management support

Denied claims are a key concern for hospitals, health systems and physician practices. The medical billing company you partner with must provide proper claims denials management and prevention strategies to reduce denials and increase the success rate of claims appeals.

Technology

Technology is another important factor to consider when choosing a medical billing service provider. The company must be able to work with your software or use its own software to manage the billing process.

Managing billing, coding, claims submission, AR management and other related tasks in-house can be time-consuming, difficult and costly. Experienced medical billing companies can help practices manage these tasks efficiently, reduce denials and maximize revenue.
 
 

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