Medical Billing Services 2019

For smaller medical practices and clinics, medical billing services are often an ideal alternative to tying up a small staff on revenue cycle management using EHR software. This article presents the advantages of using a medical billing and management service in the United States.

What are Medical Billing Services?

As the name implies, a medical billing service is a company staffed by trained medical billers that manage revenue-related functions for sole practitioners, group medical practices and healthcare clinics.

Medical Billing Service Staffing

Medical billing and coding specialists are certified and trained, including receiving ongoing training on industry updates, changes, and best practices. Regarding the importance of formal training and certification you can see the AAPC website which states, “Regulations and requirements with the current healthcare delivery system are best met when medical coders, certified in specialty practice, provide medical coding. Medical coders achieve AAPC certification through specialized education, experience in an area of specialty, and a qualifying exam(s).”¹

Medical coding involves reviewing statements and records of patient services rendered, and assign the correct billing codes using the ICD-10-CM classification system. Medical billing refers to the process of preparing and filing insurance claims or patient billing statements. Medical billers also track and follow-up on unpaid billing statements to facilitate timely revenue collections.

The medical practice will work with an account manager and sometimes work directly with the coder or billing specialist.

Advantages of Using Medical Billing Services

The industry experts at verywellhealth have this offer, “It saves time and money and eliminates the burden of concentrating on too many aspects of the medical office. “.² A list of the key advantages in using a medical billing service includes:

• Restores Focus on Patient Care: Imagine a revenue management process that is effectively running in the background. Your practice will return to feeling more like a medical office than a business office. A billing service does the heavy lifting, provides you with reports and requires minimal direct supervision.
• Optimizes Revenue Cycle Management: Your in-house staff is getting the job done, often as part of other administration duties. This means that prioritizing tasks may require billing and collections duties get put off. A medical billing service stays on top of your money with no distractions. Their focus is only on revenue management.
• Improves Cash Flow and Profitability: With a dedicated team of coding and billing professionals, your finances will improve. Promptly preparing and submitting billing statements lowers the average age of your receivables. Accurate coding means a minimal number of claims are rejected. The bottom line is money comes n faster, and less time (money) is wasted on billing problems.
• Reduces In-House Staffing Needs: When you use a billing service your requirements are reduced to sending the necessary support documentation (statement of services for a patient), answering occasional questions, and managing incoming reports. Obviously, you still need to do your own bookkeeping and taxes, but you will no longer need a large billing staff.
• Assures Regulatory Compliance: Billing errors are the number one reason payments are rejected. HIPAA violations are always a potential problem. When you engage a billing service company you are almost totally guaranteed to not have problems. The benefits are mitigating risks and consistently getting paid faster.
• Provides Exceptional Billing Records: When you need billing records, all you need to do is call or send an email. Some services offer an online dashboard from which you can print reports. This eliminates the cumbersome process of creating custom reports using your own staff.

Medical Billing Services vs. EHR Medical Billing Software

While clinicians debate which is option better, it really comes down to which is the best fit for your situation. One critical element is the amount of available staff time to effectively manage coding, billing, and collections. A small office may find a coding and billing service to be more cost-effective than hiring additional staff. A group practice or smaller clinic may find either option can work for their business.

There is one very compelling reason to hire a billing service. A billing service is dedicated to only revenue related tasks. The billing service, versus an in-house staff, is not splitting their time with other operations functions.

A small practice may not generate enough billing to justify a full-time billing and collections person. A larger practice may need one or more dedicated billing people.

If you opt to buy EHR software with medical billing functionality you need a plan to keep your staff trained. Your billing staff will need ongoing training on IDC code changes and proper financial records keeping.

Hidden Costs for In-house Revenue Cycle Management

Payment Problems Caused by Medical Billing Code Errors

How do you keep up with and manage ICD-10 code changes? In 2018 alone there were over 300 billing code changes. The timing of implementing these changes among payors may vary. This complicates efforts to submit billing that is in compliance with various payor systems. Healthcare Administrative Partners published an article on 2018 coding changes which stated, “Commercial payers may differ from Medicare in their adoption of coding changes, and so practices are advised to monitor their claims denials in the early part of 2018 to be sure any modified codes are being accepted and paid by all carriers.”.³ Trying to stay abreast of changes, and implement them into your daily routine requires a lot of work. When you outsource billing management, with one of the best medical billing companies, your practice management will probably become much easier.

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Would you like some guidance on which option is best for your practice? Reach out to a medical billing expert to get the answers you need before making a decision. Call us at 1-800-759-1321 for free information.

FOOTNOTES

• • ¹ Unknown, “Medical Billing and Coding Certification”, January 20, 2019, Available from American Academy of Professional Coders
  • ² Joy Hicks, “Pros and Cons of Outsourcing Your Medical Billing”, September 16, 2018, Available from verywellhealth
  • ³ Unknown, “Regulatory Changes Affecting Physician Reimbursement in 2018”, November 13, 2018, Available from Healthcare Administrative Partners