10 steps to find the Best Medical Billing and Coding Companies

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.

Contents

Differences between Physician Billing and Hospital Billing

CPT Coding: History, Background and How Does CPT Coding Work?

10 steps to find the Best Medical Billing and Coding Companies

Why is Digital Marketing Becoming the Industry Standard?

What is CPT VS ICD 10 & HCPCS Coding? Future of Medical Coding?

What Does a Medical Coder Do? Starting Your Career as a Medical Coder!

What are CPT Codes? Understanding CPT Codes

CPT is a standardized set of codes used to report medical, surgical, and diagnostic procedures and services to various entities, including physicians, insurance companies, and accreditation organizations. Medical bills are billed electronically using CPT codes combined with ICD-9-CM or ICD-10-CM numerical diagnostic codes.

The CPT codes are used to submit claims to federal and private payers when rendering healthcare. As CPT codes provide a detailed description of a procedure or service, they eliminate subjective interpretations of what was delivered to the patient.

The American Medical Association (AMA) developed CPT® codes in 1966 to standardize reporting of medical, surgical, and diagnostic services and procedures provided in hospital and outpatient settings.

The evolution of healthcare – including the availability of new services and the retirement of outdated procedures – is a significant consideration. Every year, the AMA releases new, revised, and deleted CPT® codes and changes to coding guidelines. The AMA also releases more minor updates to various sections of the CPT® code set.

Moreover, the AMA updates CPT® terminology or medical language to reflect advances in medicine. Though the AMA owns the copyright to CPT®, it invites participants to contribute to the ongoing maintenance of the code set and welcomes feedback on the codes and code descriptors.

Understanding CPT® codes

CPT® codes are composed of five characters. In general, codes are numeric, but some codes include a fifth character, such as A, F, T, or U. These are some examples:

92526 Oral function therapy

0638T Ct breast w/3d bi c-/c+

CPT® Code Types: A Quick Guide

Providers assign codes to every service or procedure they perform. It even includes codes for services and procedures not specifically named in another CPT® code, called unlisted codes.

The AMA has organized CPT® codes logically by classifying them into three types based on the wide range of services and procedures they cover:

CPT® Category I: Codes commonly used by providers to report their services and procedures comprise the largest body of codes

CPT® Category II: Additional tracking codes used in performance management

CPT® Category III: Emerging and experimental codes for reporting services and procedures

CPT® Category I:

Most CPT® codes are in Category I. There are a variety of existing services and procedures that are widely used and, where appropriate, approved by the Food and Drug Administration (FDA).

In general, Category I codes, which are typically represented by five characters, are arranged numerically. Codes are resequenced in one discrepancy from the expected order. In order to facilitate quick access to related codes – and help coders select the best codes – the AMA groups similar codes together. Resequenced codes occur when a new code is added to a family of codes, but there is no sequential number assigned to it.

Another exception to numerical code order involves evaluation and management codes (E/M codes). Although E/M codes begin with 9, they are printed first in CPT® code books, as you can see below in the code outline for Category I. E/M services are among the most frequently reported healthcare services, so the AMA chose this order. As with resequenced codes, this arrangement is intended for coding efficiency.

Codes for CPT® Category I fall into six main categories:

Evaluation & Management (99202–99499)

Anesthesia (00100–01999)

Surgery (10021–69990) The code range is further divided into smaller groups by body area or system

Radiology Procedures (70010–79999)

Pathology and Laboratory Procedures (80047–89398)

Medicine Services and Procedures (90281–99607)

CPT® Category II:

Four numbers and the letter F make up Category II codes, which providers can assign in addition to Category I codes. There is no reimbursement associated with Category II codes, unlike Category I codes.

The CPT® code book typically places Category II codes after Category I codes. These codes are listed as follows:

Composite Measures (0001F–0015F)

Patient Management (0500F–0584F)

Patient History (1000F–1505F)

Physical Examination (2000F–2060F)

Diagnostic/Screening Processes or Results (3006F–3776F)

Therapeutic, Preventive, or Other Interventions (4000F–4563F)

Follow-up or Other Outcomes (5005F–5250F)

Patient Safety (6005F–6150F)

Structural Measures (7010F–7025F)

Nonmeasure Code Listing (9001F–9007F)

CPT® Category III:

Category III codes, characterized by four numbers and a letter T, usually follow Category II codes in the code book. Category III codes are temporary codes used to identify new technologies, services, and procedures.

In Category III, temporary codes describing new services and procedures can remain for up to five years. They must meet Category I criteria, including FDA approval, evidence that the procedure is widely practiced, and evidence that it has proven effective. A new Category I code will be assigned to them. Providers can also eliminate Category III codes if they do not use them.

The AMA releases new or updated Category III codes semiannually via its website but publishes the deletions of Category III codes with the full list of temporary codes annually.

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