1. Claim generation and submission;
  2. Carrier follow-up;
  3. Payment posting and processing;
  4. Patient invoicing and support; and,
  5. 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
Guts of Medical Billing

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:


Possible Issues

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..