As a healthcare provider, only you can answer if hiring a medical billing service is right for your practice, and the truth is there is no one answer to this question. However, you must think your revenue cycle management could be improved, or you wouldn’t be here. Many healthcare providers have questions about whether a medical billing service can help their revenue cycle, and have even more misconceptions about what to expect.
First things first: there is no such thing as a free medical biller, and that includes your staff. Imagine this if you will. A healthcare provider in a private practice lost their in-house biller; maybe the biller retired or move away, that is not important. Now the provider must go hunting for a medical billing solution. Easy, right? There are tons of companies out there offering medical billing service, or revenue cycle management. So, the doctor turns to their office administrator 
and says, “You helped our old biller sometimes, find me a few medical billing companies so I can pick one.”
Later that week, the office administrator brings the doctor three options. All the companies offer medical billing, some offer a conjunction of revenue cycle management and support, some offer everything from software and support to collections, posting, and everything in between. The doctor likes the sound of the services but not the price. So, they tell the office administrator, “You helped our old biller from time to time, why don’t you do our billing?”
The doctor is quite happy with their creativity, they saved themselves the cost of a new biller by just having the office administrator do it. Fast forward six months: the office administrator has been doing the billing but when the doctor runs the reports to see the changes, the doctor is confused by what they see. In the last six months, the number of claims submitted has stayed the same, but the amount collected has dropped. The doctor runs some more reports. The practice’s claim rejection rate has gone up, and based on other reports, outstanding balances are not being collected as quickly as before. Frustrated by this, the doctor asks the office administrator why the billing is in such bad shape. The doctor is especially frustrated because the office administrator has been submitting overtime hours lately, but even with the extra hours the practice’s billing is worse than before. The office administrator explains that they do not always have time to focus on the practice’s claims or payment posting because they are still fulfilling their normal duties of running the office, and they have been staying late to do the medical billing work, thus the overtime hours. Additionally, the office administrator is not a professional medical biller, so they have been forced to learn as they go, resulting in more mistakes and claims rejections. Not to mention the office administrator had used all their vacation and sick days in the last six months due to illnesses.
Now the doctor faces a new medical billing dilemma. Not only does the practice need the regular billing done, but it needs someone who can clean up the mess that was created. Obviously, this healthcare provider was penny-wise, but dollar foolish, and learned the hard way there is no free medical biller. Now that the doctor has accepted that fact, it is time to ask the five key questions to find what medical billing service is right for their practice.
What about my revenue cycle management is causing frustration?
Everyone has different priorities, so the answer to this question will be different for every provider. What this question does do for you is show you where to focus your energy when it comes to changing your current medical billing situation. Is there a specific insurance rejecting your claims, or are you unable to keep up with claims appeals? Maybe you want to have a dedicated biller but cannot spare a staff member? No matter what your main objective is, be sure it is addressed when you speak to prospective billing services. After all, no one wants to be right back here in six months.
What qualifies this medical biller to handle my income?
At the end of the day, your medical biller has a great deal of control over your practice’s income. If you wouldn’t hire a gardener to fix your car, you shouldn’t hire just anybody to bill your claims. Make sure they know the medical billing industry, and specifically your specialty.
How will growth be measured?
Be sure you discuss with any prospective medical biller how you measure growth. If you measure by the number of new patients but your medical biller is measuring by the average amount charged per claim, then your metrics do not match, and you are on the road to conflict. Make sure you and your prospective medical biller are clear on the metrics that matter to you.
Does the medical billing service get paid even when I do not?
If a medical billing service wants payment even if you don’t get paid, that is a red flag. The billing service is there to submit claims and collect payments for you, not from you. Make sure they only get paid when you do. Make sure the contract you sign links their success to yours and ensure that your new billing service is obligated to follow up on rejections and outstanding balances. (No sense in leaving money on the table!)
How transparent is the medical billing service?
Another major red flag is lack of transparency. If your medical billing service will not give you direct lines to your biller and/or regular reports on your practice, it is time to switch services. This is your business, and your medical biller should be a partner in your success, not a hindrance.
If you are still uncertain, do not be afraid to ask for references. Any honest medical billing service will supply them to you, if they have them. If you want more information about medical billing service, please visit Microwize.com or call us at (800) 955 0321 option 1.
