Medical billing is a necessary part of any medical practice, doctor’s office, clinic or hospital.
You probably know that for every single medical procedure, diagnosis and treatment, there is a medical code assigned to that service. The job of a medical biller is to translate that code into a numeric value or dollar amount. That dollar amount, also known as a medical claim, is what is submitted to the patient’s insurance company. The insurance company will accept or deny the claim and send it back to the medical biller.
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The job of a medical biller is very similar to that of a lawyer: they represent their client (the medical practice) and seek to maximize the amount paid for the services their client provides.
Medical billers must be in constant communication with the patients and insurance companies in order to ensure their client gets paid. Most medical billers are highly incentivized to maximize their clients’ revenue because their fee is based on a percentage of that revenue.
The duties of a medical biller vary based on the size of the practice and the number of claims that are submitted.
Most medical billers handle the following:
It is important to know that there is usually more than one way to code a medical service. If you are a medical practice, you want to hire a medical biller who knows how to code in a way that will maximize revenue for your practice. An in-house staff person who is trustworthy and knowledgeable in negotiating insurance claims is probably your most cost-effective option. But if you are low on resources, and your staff is already swamped with other office responsibilities, consider hiring an outside medical billing service.
The job responsibilities of a medical biller and coder are closely related, but they serve two different roles.
The main duties of a medical biller include:
The main duties of a medical coder include:
A common question that medical practices ask is: Should I keep my medical billing in-house or outsource it?
As the insurance industry gets increasingly complex, more and more medical practices are choosing to outsource their medical billing. In many cases, it’s the best financial option. But, not always.
Here are some factors you should consider before choosing to outsource your medical billing:
Keeping that information in mind, scan the list below for the pros and cons of both options.
If you decide to outsource your medical billing, the next question you should ask is:
There are plenty of medical billing services out there and each company offers different services.
If you work in a GP, then you will want to find a medical billing provider that handles general practice claims. If you work for a specialist, you will want to hire a medical biller who has experience in your specialty. As the healthcare and insurance industries become increasingly complex, it’s almost impossible for one company to be experts in every area of medicine. There are always ‘tricks of the trade’ within each specialty, so find someone who knows the ins and outs of YOUR field.
Many medical billing services are beginning to offer an all-in-one approach which combines medical billing, consulting, and IT management. This eliminates the need to hire a separate company to manage software and IT issues. All-in-one companies usually cost more because of the additional services they provide, but if you want a streamlined solution, this might be the best fit for your practice.
Note: Pay attention to the background and experience of all-in-one companies. In some cases, you will find they have plenty of expertise in IT, but limited expertise in medical billing. You want someone who has experience in both.
While many of the medical billing providers are located offshore, there are also local providers. If you are shopping purely by price, an offshore billing company is going to be your least expensive option. There are plenty of reputable offshore medical billing providers, but do your research before signing a contract. Some offshore companies have little understanding of how to successfully navigate the healthcare system and insurance appeals process within the United States. Additionally, it can be challenging to communicate with a representative whose first language is not English. If you prefer a local provider who is ‘just down the street’ then you might have to pay more, but the level of service and availability may be worth it. It depends on the priorities of your practice.
Medical billing companies make their money by charging a percentage of a practice’s net revenue, net collections, OR net claims. Every provider does it differently, which can make it tricky to do a price comparison. Generally speaking, they charge an average fee that ranges between 4% and 10%.
The Bottom line: Do the numbers. If their fee does not offset your net collections, it’s not worth your money.
Once you are ready to start shopping for a medical billing service provider, here are some helpful questions to ask:
In many cases, outsourcing your medical billing will give you the most bang for your buck. As experts in their field, a medical biller’s primary job is to maximize revenue for your practice by knowing the coding system and using it to work in your favor.
Here are 5 things to look for when shopping for a medical billing provider:
Ask the following questions:
It is important to ask a medical billing service about their fee structure because not all companies do it the same way.
You have taken an important step in improving the efficiency of your medical practice. You have decided to outsource your medical billing. You need an expert, someone who will advocate on your behalf. And, you want someone who will handle the drudgery of coding, billing, collecting, and working with insurance so that you can spend more time focusing on your patients. As you begin your search for a medical billing service, you want a reputable, fair priced, proven provider.
Here are 5 things to avoid when choosing a billing service:
Some of the main complaints about a billing company that is based offshore include: