- Claim generation and submission;
- Carrier follow-up;
- Payment posting and processing;
- Patient invoicing and support; and,
- Collection agency transfer services.
Naturally, as the number of services increases, fees will increase. As a provider you will want to strike the proper balance between cost and service by honestly evaluating your own capacity to perform these functions.
There is so much more to a successful Revenue Cycle Management program within your practice or ASC.
Level of Service
In addition to the basics of medical billing mentioned above, here are some important functions that a provider and billing service should delineate before they enter into a partnership:
|Pursuing denied claims||Will the service pursue denied claims or will the provider have to? If they do pursue denied claims, a provider will want to know what procedures the company has in place to do so to ensure they aren’t being paid lip-service.|
|Billing follow up||If a patient doesn’t pay their bill, who follows up? Many medical billing services will correspond with patients regarding billing issues, which for many providers is a necessary function to outsource.|
|Complying with regulations||By handing over a patient’s medical information to a third-party, a provider becomes responsible for the third-party’s compliance with the Health Insurance Accountability and Portability Act (HIPAA). The billing service must protect patient privacy to the same degree that the provider does.|
|Reporting and analysis||One of the other benefits of a medical billing service is that they’re going to have business insight that a provider doesn’t. Will the service provide feedback about how to improve the practice? Or just send a one-page financial statement each month?|
It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service is chosen, a provider or ASC will benefit substantially from outsourcing their medical billing..