Is outsourcing your medical billing the right choice for your practice?

Standard Medical Billing Services
Standard services offered by medical billing companies are generally similar. However, there will be differences in the level, consistency and quality at which these services are provided, all depending on the size and experience of the company. The following list identifies the most fundamental services provided by any professional medical billing company.

Claim Generation and Submission
Claim generation includes the entry of patient demographic, insurance information and the transfer of data into the medical billing software. Claim submission is the process of sending that data to the carrier, either electronically (by a clearing house) or by paper submission (in the mail). For the electronic medical invoicing, the medical billing companies should apply one or more scrubbers to all submitted claims. The scrubbers are quality control tools which check the diagnosis’ and procedural codes for errors or disparities, and are often integrated into medical billing software itself. For the manual submissions, systemized quality control mechanisms should be implemented.

Carrier Follow Up
Carrier follow-up is an integral part of medical billing. Ranking of a medical billing company is often defined by the level of follow-up applied to the claims and can have a critical effect on reimbursements. By application of proper follow-up procedures, the billing company can isolate claims that go unpaid, or partially paid, and work with the medical care provider and the insurance carrier to make sure that edited claims and resubmission are correct.

Secondary, Tertiary and Workers’ Comp Claims
These claims usually require special consideration and handling, as they often need additional documentation and process knowledge. Service providers often get confused with the details and procedures required for these particular claims if not experienced and prepared.

Practice Reporting and Analysis
Quality custom reports provide critical information about avenues for improvement. These reports should be provided at least monthly, and the billing company should be able to provide recommendations for helping the practice to increase profitability and efficiency.

Patient Invoicing and Support
Patient Invoicing and Support are detail-oriented, but if applied properly can dramatically increase practice efficiency, cost control, and revenue. A medical billing service has the ability to support patient inquiries, with a customer-oriented approach, and can reflect positively on the quality of your practice.

Credentialing
Credentialing can be of particular importance for new practices. The process of initial enrollment with carriers can be difficult, overwhelming and time consuming. Credentialing services provided by a medical billing service can also help established practices expand their business.

Medical Coding
Coding is the first step in setting up the billing process. Working with a Certified Procedural Coder to implement the proper, updated, diagnosis codes and procedural information, will minimize the number of claims for resubmission and increasing timely cash flow.

Conclusion
As a large and experienced medical billing company in New York, we are proud to provide all the services listed above with consistent quality and personal attention to every account.

Pier 17 Professional Billing Service, Inc. may become a valuable asset in your practice’s future success.

Inessa Sable, vice-president