Medical billing services have long been overlooked by the healthcare industry as a pain to deal with. That is why healthcare providers large and small tend to only do the bare minimum to ensure that they collect all the money that they are owed for their medical services. In recent times, software, automation, and emerging technologies have started taking over the healthcare industry and causing massive disruptions in the ways healthcare providers have been doing business thus far.

In order to stay in business, it has become increasingly important for healthcare providers to handle denial management, aging AR, and the appeals process with greater efficiency. While there are technically thousands of factors that you would need to look at to evaluate how good a medical billing services company is to partner with, we have simplified that process for you.

We have compiled a list of 9 critical primary and secondary factors that you should look at before choosing to outsource medical billing to a particular company. Let’s take a look:

Primary Factors to Consider When Looking for an Outsourcing Partner for Medical Billing Services

Outsourcing Partner for Medical Billing Services

Here are a list of 6 critical factors you should look at before you outsource medical billing to the experts and choose an outsourcing partner:

Demonstrate Extensive Industry Experience in Medical Billing and Coding

The first thing that you should look for in any medical billing outsourcing partner is how long they have been in the business. This will tell you a lot about the depth of experience they have in medical claims processing, AR management, billing and collections, HIPAA compliance, denial management, etc. Medical billing outsourcing companies that have been around for over 10 years will have spent enough time handling all these diverse aspects of medical billing.

Their years of industry experience would have helped them learn many tricks of the trade that amateur contenders would not know about. You should also look into the growth of the company over the years.

Have they managed to expand their talent pool dramatically over the years or are they still small players in the industry with a limited talent pool? Have their operations taken on greater scope in handling greater volumes of claims and medical bills or do they still operate with infrastructure and processes that were implemented years ago? Understand their industry experience and how much of an authority they are in their field to see whether they would add value to your business while working with them.

In-Depth Knowledge of ICD-10 Regulations

Any respectable medical billing and coding companies worth partnering with would have been in the industry long enough to have gained in-depth knowledge of ICD-10 regulations and coding protocols. Enquire about how extensive their ICD-10 knowledge is and how well-trained their coders are in those systems to get a sense of whether they would be a good fit for you or not.

Medical billing and coding specialists convert procedural and diagnostic data on a patient’s chart into predetermined 5-digit CPT codes that represent the service or treatment that was provided. Services that are covered can include anything from doctor visits and lab specimens and tests to X-rays and surgeries.

In situations where more detailed information is required than the existing code provided, modifiers are added to the CPT code for a more elaborate explanation of the treatment or procedure. Medical coders and billers must choose the right code to validate the services the patient received. A medical billing company that has little knowledge of ICD-10 codes is far more likely to submit miscoded claims that could result in insurance companies refusing to cover the services provided.

Having a medical billing company that has extensive ICD-10 expertise can greatly enhance the billing process and enable the medical facility to receive their payments with greater speed and accuracy.

Ask If Denial Management Support Is Included

denial management services

One of the biggest components of medical billing is denial management and the appeals process. It is critical that you outsource medical billing to a company that is well-versed in denial management above all else. This is because it is one of the most difficult aspects of medical billing to manage. From A/R follow up and claims status checks to denial resolutions and appeals letters, there is a lot to take care of with denial management.

Due to a lack of expert knowledge and time, many healthcare facilities are failing to manage denied claims and resubmit them on time. Denial management requires both timely execution and expert knowledge, without which the claim will immediately be written off as uncollectable. This requires a dedicated team of skilled professionals.

These denial management specialists analyze the different denial trends and initiate actions that will impact many claims with a simple resolution to prevent the repetition of the same denials. You need to ensure that you choose a medical coding services company that tracks denials, identifies root causes of denials, and executes denial management prevention strategies.

You should also ask about whether they provide feedback to the appropriate physicians and internal personnel on denial management trends and findings. This way you can get a firm grip on denial management for your healthcare facility.

Ensure They Meet HIPAA Compliance Standards

hipaa compliance in medbilling experts

One other important factor to consider when hunting for the right medical billing outsourcing partner is whether they meet HIPAA compliance without fail. Medical billing companies that are 100% HIPAA compliant use the right standardized codes for all their claims.

They use the appropriate ICD codes for diagnosis and the right HCPCS and CPT codes for procedural reporting. They also deal with sensitive information on a daily basis. Not only will they handle provider and patient information, they will also handle insurance information that must be kept secure at all times.

To top that, your medical billing and coding specialists will be responsible for helping with the secure physical and electronic transfer of sensitive medical information between these parties. Any non-compliance or failure to follow the guidelines may result in a federal investigation so it is critical that all measures are taken to meet HIPAA compliance requirements at all times. Basically, the idea behind HIPAA compliance is for healthcare entities to ensure they protect personal health information and the critical privacy right of the patients at all times.

When looking for the right outsourcing partner, ensure that you verify how compliant that company is with HIPAA regulations so that you know how safe your data will be with them.

Experience in a Wide Variety of Specialties

When looking for a good partner to outsource medical billing to, you should always consider how many medical specialties they are versed in submitting claims for. This is because you should only go with medical billing companies that have experience billing for a wide variety of medical specialties.

This is important because what you are billing for with anaesthesiologists will be very different from what you will be billing for with dermatologists. Having wide exposure to a host of specialties will make your medical billing partner that much more valuable in case you ever expand the medical practice to include more specialties.

From audiology, neurology, and dermatology, to orthopaedics, gynaecology, oncology, and urology, there is no limit to how many medical services a hospital can provide and bill for. It is critical that you outsource your requirements to medical billing companies that have fair knowledge of many specialities so that you are covered no matter what medical services you provide.

Prioritizes Patient Engagement

It is also important that you look to partner with medical billing outsourcing companies that know their priorities right off the bat. Because you will be collecting payments from only 2 parties, you need to ensure that all lines are open to receiving those payments on time. When a healthcare provider is looking to get payments from their patients, it first must take care of patient engagement.

Right from the first encounter, you must ensure that you are always catering to your patients needs. You must also make it very clear to them that they have financial obligations to take care of when getting medical services from your facility. You can start by letting them know that you have a patient portal that they can always visit to set up more appointments, get more information, or submit feedback using. This portal can also be used then to collect payments as reminders for payments are sent to them regularly.

Keeping your patients engaged the whole time will ensure that you get payments coming in with greater frequency and consistency than not informing them that you care for their entire patient journey. Ensure that you choose a medical billing outsourcing partner that prioritizes patient engagement so that payments can come back to your facility with greater ease and regularity.

Secondary Factors to Consider When Looking for an Outsourcing Partner for Medical Billing Services

Outsourcing Partner for Medical Billing Services
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On top of the primary factors to consider, there are a few secondary factors to consider before outsourcing your medical billing services to a third-party vendor. These secondary factors include:

Falls Within Your Budget

Which business does not look to cost cutting first and foremost when making any business decision? Although it is important to consider the cost of hiring a particular medical billing outsourcing partner, it is not the most important criteria. There are plenty of outsourcing partners that are premium service providers and then there are just as many that are impressively affordable.

What you need to be looking at is the value they bring to the table; not how much money is leaving your pocket to partner with them. No matter what you do you will be spending money, so make sure that the money you spend is helping you bring in quality services where all your priorities are being met. This can include ensuring that they are HIPAA compliant and are experts when it comes to ICD-10 regulations.

It can also include providing maximum patient engagement and having industry experience that beats out all other competitors. Be sure that the outsourcing partner you decide to go with goes to great lengths to provide comprehensive medical billing services so that you are not left empty-handed in some critical areas. Once you have found a medical billing services company that provides all the services you need, you can then look at the budget that you are working with.

Detailed Reporting for Denials, Operations & Analytics

It is also very important that you choose a vendor that prioritizes reporting as a fundamental service they provide. Without adequate reporting capabilities, you will always be left in the dark in terms of how your processes are running and which areas need improvement and how. Ensure that you look into the types of reports that are generated by them on a regular basis to see whether they cover your requirements. If you need detailed reports on claims denials, operations, and data analytics do not settle for a vendor that provides you with just claims denials and operations reports.

Only what you measure can be improved so ensure that you outsource medical billing to a company that measures everything you need them to. That way you can compare key performance indicators and other metrics to figure out where your healthcare facility is lacking and how they can be improved over time.

You can also use these detailed reports to assess how operational performance changes over multiple time periods so that you can implement new strategies to fix problem areas. Reporting will give you insight into the operations, denial management processes, and data of your medical facility that you would otherwise not have. So ensure that you ask about the kinds of reports you can expect to receive on a regular basis so that better business decisions can be made as a result.

Assess Vendor’s Size and Scalability

It is also critical that you evaluate the size of the medical billing services company you decide to partner with. By assessing its size, you can better determine how easily they can take on your requirements. If they are not very large in size, the number of claims they can process and generate will be limited.

Should you ever face an influx in the volume of medical claims that you have to bill, you need to make sure that the medical billing services company you have partnered with will be able to handle it. If you were to partner with a medical billing services outsourcing partner that is larger in size and has the talent pool at their disposal to process that many claims, you are saving yourself a lot of trouble in the future.

Whatever you do, ensure that the outsourcing partner you go with has no scalability restrictions because that will cost you in the long run. If they are able to handle both a larger volume of claims with ease as well as a fall in volumes with zero disruption to their operations, you are barking up the right tree.

Outsourcing medical billing services can be a tough nut to crack. You want to make sure that you have covered all the bases before you choose one specific company to partner with. Although there are thousands of variables or factors to evaluate to help you find a good fit for your business, only a handful truly matter.

Out of that handful, there are primary factors like industry experience and HIPAA compliance that you have to assess, and secondary factors like your budget that you will have to weigh in on. To ensure that you have picked the right vendor, however, look into critical factors like exposure to a wide variety of specialities and their ability to prioritize patient engagement.

These last ones will give you a better sense of how they operate and what they value over everything else. Your values will need to coincide in order to ensure that you have a healthy partnership that sees eye to eye on important decisions long term.

Who We Are and Why We Are an Industry Authority?

This article is brought to you by MedBillingExperts, a leading healthcare solutions provider that has been operating in the healthcare industry for over 10 years now. We are experts at developing unique and effective medical billing solutions for our clients as we have witnessed and thrived through many transformational changes that have affected the industry over the years. It is through our industry exposure and vast experience that we are able to help our clients plug different sources of revenue leakage, help them obtain greater compliance, and address costly inefficiencies in their operations.

We provide enterprise-grade medical billing solutions to our clients to ensure that their denial management, aging AR, and appeals processes are efficient and highly effective at all times. This helps them stay ahead of their competition as they bring in greater revenue through improved collections and accelerated reimbursement practices that we have deployed across their organization.


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