1. Expertise and Accuracy
2. Improved Revenue Cycle Management
3. Reduced Administrative Burden
4. Access to Technology and Resources
5. Compliance and Regulations
6. Cost Savings
7. Better Focus on Patient Care
8. Consistency and Accountability

Proper medical billing is crucial for several key reasons, benefiting both healthcare providers and patients:

• Financial health: Accurate and timely billing ensures proper reimbursement for services rendered, leading to healthy cash flow and financial stability for the practice or facility. Denied claims due to billing errors can significantly impact finances.
• Regulatory compliance: Proper billing adheres to complex healthcare regulations and coding standards, minimizing the risk of audits and compliance fines.
• Data analysis and decision-making: Accurate billing data helps track resource utilization, patient demographics, and treatment patterns. This valuable information can inform strategic decisions on staffing, resource allocation, and service offerings.
• Patient satisfaction: Clear and transparent billing practices contribute to positive patient experiences. Patients appreciate receiving accurate bills that explain their charges and avoid unexpected surprises.

• To Increase Your Net Collections
• To Reduce Your Accounts Receivable
• You Can Improve Your Cash Flow
• You Can Save Money
• You Can Save Time
• You Can Get Better Service
• You Can Have Peace of Mind
• You Can Focus on Your Patients
• You Can Get Expert Help

Most medical billing companies charge their clients based on a fee structure.

1. Percentage-based fee: Charges a percentage of the total collections.
2. Flat fee per claim: Charges a fixed fee per claim processed.
3. Monthly retainer fee: Charges a fixed monthly fee for services.
4. Hourly rate: Charges an hourly rate for the time spent on billing tasks.

The most common fee structure is percentage-based, which is the most effective since you’re only charged for services actually rendered, and the percentage tends to decrease as your collections increase. The standard pricing percentage is around eight percent, but you should always double-check if they charge extra for services like patient collection or follow-ups since lower-priced companies may exclude standard services to seem less expensive.

Like any new partnership, you probably want to know if your practice is in good hands with a medical billing company. By asking them for references, you can hear first-hand experiences from other offices about their relationship with the medical biller. This could save you a lot of time if you discover a company is unreliable, inexperienced, or unprofessional. Ask the references how long they’ve worked with the biller and if they could handle their needs, especially if your practices are similar.

Reliable medical billing companies, like R29, care about and work closely with providers, payors, and patients. The best medical billing company should utilize data-based data to help billing partners grow and expand their business on all levels, from operations, marketing, and outcome measures. Good references need to be thought leaders and trailblazers in the billing industry, always adapting and implementing educational opportunities for clients and their clinical staff.

A reliable and experienced medical billing company should have an extensive background in medical billing for different healthcare providers, like behavioral health and ambulatory surgical centers. Even if the company is new, its employers and founders should come from related fields. Hiring a new company with no previous experience could turn out okay, but chances are you’ll spend more time helping them refine their skills rather than improving your own.

Always ask what kind of training and certifications the staff have. Find out if their team members have received proper training in medical billing and coding. Certification from recognized organizations, such as the American Academy of Professional Coders (AAPC) or the Professional Association of Healthcare Coding Specialists (PAHCS), can indicate a higher level of expertise and knowledge. You also want to make sure they regularly train and update their staff with the latest CPT and HCPCS codes to prevent claim denials due to outdated code submissions.

Ask the medical billing company if they have worked in your field before and if they have experience with your specific needs. For example, in a pediatric clinic, medical coding may involve specific codes for childhood vaccinations, growth and developmental assessments, and pediatric-specific procedures.

On the other hand, a dermatology office may focus on coding procedures related to skin conditions, such as dermatological surgeries, biopsies, or laser treatments. Each specialty has its own set of procedures, diagnoses, and treatments that require a medical billing company familiar with your field.

When you’re looking into medical billing companies, chances are you’re looking to adjust and change your system to improve client satisfaction and revenue. But you can also have some existing processes that work and don’t need adjusting. When you meet with a medical bill company, ask them if they can keep or integrate some of your successful processes into their new system. If the company wants to change a lot, ensure they’ll train and orient your staff with their system.

Before hiring a medical billing company, ensure that your billing and patient data always belong to you, are easily accessible, and are safe and accurate. This will give you the freedom and ability to take your data with you if you decide to switch medical billing services or bring your billing processes in-house. Medical billing companies like R29 prioritize providing real-time data to help create quality treatment plans, strategic business decisions, and informed choices. By maintaining ownership of their billing data, healthcare providers retain control and can make informed decisions regarding their billing processes.

Accreditation or affiliation with reputable organizations like the Healthcare Business Management Association demonstrates the medical billing company’s commitment to upholding industry standards, ethical practices, and ongoing professional development.

You also always want to ensure your medical billing company is HIPAA compliant. By partnering with a HIPAA-compliant medical billing company, healthcare providers can have confidence that their client’s protected health information (PHI) is handled securely, reducing the risk of data breaches, unauthorized access, and potential legal consequences.

Understanding who will work on your account is crucial when selecting a medical billing company. Meeting or talking to the individuals handling your billing processes allows for personal connection, trust-building, and collaboration. It also provides direct access to dedicated points of contact, enhancing responsiveness and accountability.

Ensuring consistent service levels even when the regular team members are unavailable is crucial when selecting a medical billing company. It is important to inquire about the company’s contingency plans for situations such as vacations or illnesses. Ask if they cross-train their employees to handle different accounts and if they guarantee uninterrupted service.

Cross-training employees within the billing company ensures there are qualified individuals familiar with your account who can step in when needed. This mitigates the risk of disruptions or delays in the billing process.

Ensuring transparency in the billing processes is crucial when choosing a medical billing service. Inquire about the frequency of receiving reports that provide a clear financial snapshot of your business and the billing service’s progress. Understand how the company will communicate with you and the level of involvement you will have in the billing processes.

Medical billing companies should be up-to-date and consistent with emerging technology and processes. This includes verifying patient insurance eligibility electronically, submitting claims electronically, and receiving remittance advice electronically for efficient processing and faster reimbursement.

A reputable medical billing company should also provide convenient options for patients, such as credit card processing and online bill pay. Offering secure and user-friendly credit card processing allows patients to conveniently settle their medical bills, reducing administrative burdens and enhancing the overall patient experience. Similarly, online bill pay empowers patients to make payments easily from the comfort of their homes, enhancing convenience and reducing paper-based processes.

Always ask the medical billing company about all of their services. Assuming they offer something other companies do can cause issues down the line. Some billing services may specialize in certain areas or provide additional services beyond basic medical billing, such as coding audits, denial management, or revenue cycle analysis. On the other hand, some companies may only offer basic plans to keep their pricing low and appeal to smaller practices.

Not all billing companies offer this service, but it is highly advantageous to choose one that does. Being notified of contract issues ensures that you know if any of your payers are reimbursing you at a lower rate than what you are contracted for, such as receiving only 75% of the contracted reimbursement instead of the agreed-upon 120%.

By receiving timely alerts about such discrepancies, you can take immediate action to rectify the situation. This may involve contacting the payer to address the issue, providing documentation to support the correct reimbursement rate, or renegotiating the contract terms if necessary. Without this proactive alert system, you may unknowingly accept lower reimbursement rates, leading to financial losses for your practice.