Category/ Medical Billing

10 steps to find the Best Medical Billing and Coding Companies

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10 steps to find the Best Medical Billing and Coding Companies

Outsourcing revenue cycle management to medical billing and coding companies can be a beneficial experience for healthcare organizations. Over the last few years, the outsourcing market has grown in this area. The Healthcare Business Process Outsourcing Market report for 2022–2025 predicts that the market size for these services is expected to increase by USD 7.43 billion between 2022 and 2025. As a result of the scarcity of staff, With the growing needs of healthcare organizations during the pandemic, RCM companies have become increasingly important.


Although there are many options available on the market, it can be pretty challenging to choose the right partner. For the best results, you need to take into consideration the various pros and cons and then balance them with the financial budget. As the RCM company is going to handle sensitive data for your organization, you should also check out its credibility. This article walks you through 10 easy steps to evaluate and choose the correct medical billing and coding company.


Determine the size of your account:

Despite the fact that there are numerous medical billing and coding companies in the market, few are capable of handling all account sizes. Identify the scale of your practice and your accounts in order to know what revenue cycle management company to hire. A conclusion can be drawn by evaluating aspects like the estimated budget, the number of physicians, and the accepted insurance companies. The following steps will help you decide whether to hire a small-scale billing service, narrow down specific steps of billing, or hire an end-to-end revenue cycle management service.


Taking stock of past experience:

A revenue cycle management company with many years of experience has managed the changing healthcare billing ecosystem. Partnering with a company with strong credentials and proven experience dealing with accounts for another healthcare system can be useful. Make sure the company has been in business for a long time. Be sure to ask for testimonials from their clients. Consider reading reviews of real healthcare providers instead of generic ones to get a better sense of how their customers have been successful.


Professional Experience: 

Medical billing poses a unique set of challenges for every medical specialty. It is important to find companies that have demonstrated their ability to provide services for the specialties you are looking for. In the case of an organization with multiple specialties, ask the company if it is up-to-date with the latest practices. Even if you have a general practice right now, it may be a good idea to expand into specialties. It is important for your outsourcing partner to be able to grow with you.


Number of employees: 

Staff members in the billing department are ultimately responsible for doing the groundwork. It is important that your medical billing provider has enough staff to handle your account. The sheer number of bills you may receive at non-peak times might overwhelm you without the support of enough trained professionals. Determine the number of people who will manage your account and provide emergency support.


Estimated costs: 

One of the most important factors to consider when selecting a medical billing and coding company is the budget. You can choose between different types of costs. There are two types of fees: a flat fee and a percentage of the revenues collected. When it comes to getting a reasonable price, it is vital to compare multiple quotes from a few vendors. However, you should also consider the quality of the services being offered.


Measures to ensure compliance and security:

RCM companies’ credibility is based on compliance and security. Account billing professionals will have access to sensitive medical information about patients when dealing with your account. Verify that the IT systems are secure multiple times to ensure the safety of PHI. Medical billing and coding companies must maintain HIPAA compliance as a security building block.


Management of Claim Denials: 

Despite taking all the necessary steps, some insurance companies may reject your claim. Get an idea of the denial rate from the companies. A survey reported that more than 60% of billing professionals never edit or submit a denied claim within the given deadline. Thus, it is very important to know how your outsourcing provider plans to deal with these issues.


Advancements in technology:

Errors in medical billing can be a result of typographical mistakes or incorrect or outdated insurance information, among other things. In order to maintain revenue integrity, these issues must be handled with proper software solutions. Make sure your medical billing company is using the right tools to make sure there aren’t any mistakes with your bills.


Services and Support:

Medical billing and coding companies can benefit from maintaining a good customer service record. Companies that lead the way in RCM ensure that their internal counterparts are kept in the loop so that information does not lag. Discuss the different modes of communication you can expect from the billing team, including chat, email, and phone calls. The organization will become more effective if you have a responsive staff.


Additional Services Offered:

Many RCM companies offer more than just billing and coding. They can also provide EHR companies with additional services, such as provider credentialing and customer service. You can also ask them if they offer any additional services in these fields if you’re suffering from any other back-office issues. An RCM company that is well-known will help you run your business better when you work with them full-time.


A business may find it overwhelming to select a vendor from several options. If you follow the above steps, you will be able to narrow down your options to one that matches your needs.


The article above explains how you can choose a medical billing and coding company among a number of options. Please feel free to contact us if you have any queries.


Differences between Physician Billing and Hospital Billing

Physician Billing vs. Hospital Billing: Understanding the Key Differences


Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.


With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, its based on the pricier reimbursement model, where the hospital charges the patients insurance plan for the services required and received.


Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.


To highlight the key differences between physician and hospital billing, lets find out how they are used in both cases.


Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
•    Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments. 
To make sure that the organizations overall financial and operational goals are met, people who work in medical billing and coding need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical offices billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly. 
The organizations ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
•    Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
•    All outpatient and inpatient services will be billed based on the patients insurance policy, so its important to check.
•    It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both billing and coding procedures. Healthcare professionals offices and hospitals employ medical billing and coding teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. Scribe Align makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like Scribe Align, you can focus on the doctors practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

•    The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
•    A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
•    An institutions configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
•    A physicians billing is similar to a hospitals billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
•    The hospitals appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.


Billing for Physicians and Hospitals: how to increase revenue?

•    Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
•    Keeping track of unbilled and unmissed claims and services becomes the physician billers priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
•    Outsourcing healthcare billing and coding services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
•    The hospital billing process is quite different from physician billing. A hospital or institutions billing function includes collection and billing.
•    As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.

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