What does a medical billing company do?
Medical billing in itself is a daunting task. It is a complex process involving different parties. It includes submitting medical claims and receiving payments from the insurance companies for the healthcare services provided to the patient by the healthcare provider. Now in order to get paid for the services rendered, medical billers should be up to date and be in touch with the insurance payers, their regulations, and changes in their regulations along with government agencies to make sure timely reimbursements and revenues. Even a slight mistake in medical billing can result in claim denials and lost payments. Medical billing involves using the right modifiers and codes for keeping the clean claim rate higher. Therefore, higher reimbursement rates and an improved revenue cycle. These revenues keep the hospitals or medical practices open for the patients in need.
It might seem that a patient is just going to see a physician (a two-party interaction) when in reality it involves a complex process of the payment system. It involves three parties, the patient, the provider, and the payer. The provider is the physician, doctor, hospital, ER (emergency room) providing the medical care is being provided to the patient. The payer is the insurance company or carrier.
Medical Billing and Coding Specialists:
Medical billing and coding are the two major and most critical processes of any healthcare system. Hospitals or medical practitioners hire medical billing specialists or a team of them to handle the medical claims, processing, submission, and denial processes, the right way! The medical care providers can choose to hire medical billers in-house or outsource their billing process to third-party medical billing companies. A healthcare medical billing company is responsible for ensuring that the medical care providers receive the proper payments for the medical services provided by the medical practitioners. These companies gather patients’ complete medical information and data (records), use the right codes and modifiers in medical billing to generate the claims.
Following are the tasks handled by the physician billing companies:
- Ensuring that the medical claims being submitted are scrubbed of all errors.
- The patient medical and other information is correct and up to date
- Optimizing and improving the revenue cycle
- From preparing the medical claims to handling the claim denials
- Streamlining the workflows and cash flows
But what is the difference between in-house and outsourced medical billing specialists?
Difference between In-house & Outsourced Medical Billing Services:
In-House Medical Billing Services:
In-house medical billing services include hiring a medical biller and coder or a team of specialists to handle the medical claims. Following are the pros and cons of hiring an in-house medical billing resource:
Pros of in-house medical billing:
The biggest benefit of an in-house medical billing team or personnel is that you can monitor the day-to-day process. If you want to have complete control over the medical claim processing and data input, in-house hiring is the way to go.
– Close by team:
With in-house medical billing, you get a team within close proximity. This means if there is any kind of issue that needs attention the physicians and administration can easily discuss the situation with one another. The problems can be addressed one on one, in real-time as they are just a floor or so away.
Cons of In-house Medical Billing services:
– Higher expense:
If the medical provider decides to have an in-house medical billing company, they have to bear the administration costs, medical billing software costs including computer hardware costs. Above all of these, the time cost of hiring a medical billing resource.
– Risk of interruption:
With in-house medical billers and coders, what if one employee goes on leave or on a break? This disrupts the complete medical billing and coding process, therefore, reducing the productivity and loss in payments due to late medical claim submissions or errors.
Outsourced Medical Billing:
Outsourcing your medical claims means that all the day-to-day medical billing operational tasks will be handled by a company. The complete billing process will be handled by the off-site medical billing company, from preparing the claim to the claim submission including the follow-ups of denied claims. Outsourcing your medical billing services to a third party is a huge step but it can reduce a lot of stress monitoring the claims, denials, and the administrative staff as it can be hectic for the healthcare physicians who are also providing the patient care. The off-site medical billing providers are the best option in the following cases:
– If you can’t handle or manage an in-house medical billing resource/s full time.
– Medical billing outsourcing company/s are the industry experts, meaning they know what questions to ask, who to talk to regarding claim denials, they are up to date about the payer’s (insurance carrier) regulation and changes. In short, they know how to get the work done, in time and avoid late submissions and claim denials.
Pros of Outsourced Medical Billing:
– Focused Patient care
With outsourced medical billing services, physicians or medical practitioners can focus solely on providing safe and better healthcare without the worry of monitoring or handling the medical claims, denials, and timely submissions.
– Increased Efficiency and Quality
A team of highly specialized medical billing and coding professionals ensures the quality of claims being submitted to the payers in order to avoid denials and late submissions. Hence, making the complete medical billing process efficient and hassle-free for the healthcare provider.
We get paid when you do! With UControl Billing you can avoid the fixed administration cost of in-house medical billers and just bear costs that are based on your monthly receipts. Our billing drops as well if your production goes down.
– Lesser errors
With a team of specialists preparing and submitting the medical claims you wouldn’t have to worry about errors. The claims will be scrubbed of all errors before submission and in case of rejection, the medical billing company will be the one to handle all the fuss.
– Uninterrupted service
UControl Billing offers you uninterrupted service for medical billing. Our team of specialists is available to answer patient calls, and provide you (the healthcare provider) with timely follow-ups and billing in 24 hours.
In case of any issue like claim submission, issues impacting your cash flow we are always available. With the unavailability of one or more employees, we always have a replacement so your workflow doesn’t get affected.
– Higher revenue and increased cash flows
With outsourced billing services, you get a team solely working on streamlining your workflow and improving your cash flows, thus increasing reimbursement rates and revenues.
Best medical billing companies offer you user-friendly implementation. With UControl Billing, you get just that. We offer easy and simple implementation of RCM (revenue cycle management) services.
– Single point of contact
Coding and billing companies are the sole point of contact for healthcare providers. Meaning, with outsourced billing, the healthcare providers don’t have to communicate to a variety of insurance payers. Instead, the medical billing company does that for you. You just have to be in touch with the billing company, thus your single point of contact.
– Up to Date:
Insurance carriers are changing their regulations often, which is why medical billers (in-house or outsourced) should be up to date about all the changes about every single insurance carrier and prepare the medical claims as per their requirements which can be very hectic and result in errors or late submissions (if now updated)
Whereas, medical billing companies are in the industry of billing medical claims, dealing with insurance carriers is their day-to-day work. They know how to deal with the insurance carriers and resolve the rejected claims.
– HIPAA Compliance
HIPAA stands for The Health Insurance Portability and Accountability Act. This act was developed in order to protect the patient’s medical information and personal data. HIPAA safeguards the personal information of the patient. UControl Billing is HIPAA compliant.
Benefits of HIPAA Compliance:
Note that being HIPAA Compliant isn’t a choice, it is a compulsion and requirement for medical billing.
– Improved efficiency
– Protected healthcare data
– Increased confidence of the patient in the company
The Title II of HIPAA directly applies to medical billing companies.
Looking to outsource medical billing services?
When outsourcing your billing services to a third party following are some of the points to be considered:
- Check for their Client Base
- A team expert in medical billing and coding.
- Efficient and provides high-quality services
- Compliance with HIPAA
- Analysis of their cost and your budget
You need to be thorough when choosing the right medical billing company. Because if medical billing isn’t done right, it directly affects your RCM. If you decide to leave the office work to the professionals (outsource), you would want to choose the medical billing company that suits your needs perfectly. Out of a wide variety of medical billing companies in the industry, choosing the best option for you can be overwhelming. This is why first identifying your needs is a critical part. Then make a list of medical billing companies that suit your needs. Following are some of the steps to choose the best medical outsourced billing company.
Steps for choosing a Medical Billing Company:
1. Your practice’s scale
When looking to outsource your medical billing services to an off-site company, first determine your practice’s appropriate scale i:e- your budget, number of insurance carriers, and size.
2. List down the experienced companies
After identifying your scale, look for a medical billing company that specializes in your practice scale (small or large number of patients or insurance carriers).
3. Cost budget analysis
Make sure that you get the best deal. Get a cost breakdown beforehand from the company and do the cost budget analysis. Make sure there are no hidden costs.
4. Look for compliance
Ensure that the medical billing company is compliant with HIPAA.
5. Company reviews
The client base says a lot about the company. Look for a strong client base when choosing a company to outsource your medical billing services.
6. Compatibility with your software
Shifting to a new software takes time, hence slowing the operations. Ensure that your software is compatible with theirs as in case of compatibility issues, it can consume a lot of time, money and it needs special training (ask if they provide any before) to manage operations.
7. Make the decision
Find out about the number of medical billers working for your healthcare company. Based on data gathered from all the above-mentioned steps, make a wise choice! Choosing the right medical billing company according to your needs and requirements is critical. And having the best medical billing services can make all the difference.
Why UControl Billing?
UControl Billing ticks all your boxes, literally. We have a strong client base, efficiency, compliance with HIPAA, and a business offering simplicity, good performance, and user-friendliness. If you are looking to outsource your medical billing services, UControl Billing is the way to go.
Following is a list of services we offer at UControl Billing:
– Medical Billing services
– Medical Coding services
– Front Office Management
– Telemedicine Billing
– Revenue Cycle Management (RCM)
– Medical Credentialing
– Medical Transcription
– Value-Added Services like
o MIPS MARCA Eligibility
o Medical Billing Reports
But why choose UControl Billing for Outsourcing Medical Billing Services?
UControl Billing is an American Billing company. We ensure 100% privacy and discretion in a secure environment. We think of ourselves as “Remote Business Office” giving you the feeling that we are right there with you, always available to answer any questions you might have. We offer:
– Competitive Prices
– Uninterrupted Services
– Higher Reimbursements
– Compliance with HIPAA
– Increased revenues
– Patient support and customer services
– Timely Follow-ups
– Reduced Account receivables
We believe in providing you with the best medical billing services, streamlining your workflow, and increasing your cash flows. UControl Billing is a reputed medical billing company with a wide client base and a team of skilled medical billing and coding professionals. A team who scrubs your medical claims from any errors, with timely submissions, and is available to answer any of your questions. Ensuring lower claim denials, and increased reimbursement rates. Saving the time, you spend on preparing, processing, and follow-ups of the medical claims. With UControl Billing, you have control over your patient care.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.