The 3 most important questions to ask your medical billing service
The simple way to evaluate your medical billing
3 questions to get clarity
You probably are not an expert in medical billing.
Good news: You don’t need to be.
You only need to know how to identify an effective medical billing service – one that will:
Improve your clean claim rate
Reduce your collection times
Increase your revenue & profits
Of course, an ineffective medical billing service will do the opposite!
But when you ask the right questions, it’s not hard to tell the difference.
The 3 questions you need to ask are:
How do you ensure that each claim is submitted, approved, and paid as rapidly as possible?
What is your process to address rejected claims?
How will your team communicate with my office staff?
The answers to these questions will tell you whether a medical billing service will be effective.
Here’s what to look for:
Question 1: “How do you ensure that each claim is submitted, approved, and paid as rapidly as possible?”
Insurance companies today scrutinize each claim for an excuse to delay or deny payment.
You can’t give them an opportunity.
Here’s how your medical billing service should respond:
Key response #1: “We carefully review every claim before submitting it for payment.”
When you submit a claim, you must be 110% certain it is complete an accurate.
That process starts in your office, but your medical billing service should verify that every claim you send out is “clean” i.e. it meets the insurance company’s requirements and will be paid immediately.
If your medical billing service doesn’t thoroughly review all your claims, you WILL submit claims with simple errors, and these WILL be rejected.
This will lead to delays in payments, or even outright denials.
Key response #2: “We submit all claims within 48 hours.”
When you submit a claim, literally every day counts.
Any delay in submission can easily lead to a much longer delay in payment.
Your medical billing service MUST review and submit your claims thoroughly, efficiently, and without delay.
Anything longer than 48 hours is unacceptable, and will likely lead to delays, denials, and lost revenue.
Key response #3: “Our billing software and systems are fully up to date at all times.”
The medical billing and insurance industry is always changing.
With each new software update, something could go wrong.
When things go wrong, your claims will be delayed, and – again – delays can easily lead to denials and lost revenue.
Your medical billing service should
Key response #4: “Our clearinghouse performs a thorough secondary review of all claims for accuracy.”
The right clearinghouse is key to successful medical billing.
An effective clearinghouse will:
Shorten claim processing times
Facilitate rapid correction & resubmission of denied claims
Help create processes to prevent errors in the future
Also, different clearinghouses may focus on claims to specific insurance providers. For example, Blue Cross and Medicare each have specific requirements, and a specialized clearinghouse may have better success with these insurers.
But remember:
You don’t necessarily have to understand all this.
Your medical billing service does.
Just make sure they explain to you why they use a specific clearinghouse to process your claims.
This brings us to the second question…
Question 2: “What is your process to address rejected claims?”
Some claims will be rejected. It’s inevitable.
When that happens, your medical billing service must implement a robust process to ensure that each rejected claim is corrected and resubmitted, without delay.
Keep in mind:
Every day counts.
Here’s what you should expect from your medical billing service:
Key response #1: “We immediately identify the specific issue with each rejected claim.”
When a claim is rejected, there’s always a specific reason.
It’s not random.
When a rejection happens – and they do happen – your medical billing service needs to follow up immediately.
Any delay - at all - increases the chance that you won’t get paid.
As soon as an insurer flags a claim as invalid, your medical billing service must identify the cause of the rejection immediately, and - if necessary - begin the process of gathering the information to correct and resubmit the claim.
Often, correcting the error will require additional info from the practitioner.
That’s you and your staff.
Which brings us to item #2…
Key response #2: “We communicate directly with your office staff to gather any missing information.”
Did you know:
85% of issues with rejected claims begin in the provider’s office?
Here’s the bottom line:
Your medical billing service needs to work closely with your office staff to resolve any issues.
In most cases, your own staff will need clear instructions from your medical billing service to reduce office errors, and to create processes to submit claims in a way that minimizes rejections.
Otherwise, the same problems will recur over and over.
Which will lead to lost revenue.
Which brings us to the next point…
Key response #3: “We create processes to prevent errors from recurring.”
You know the saying:
“Don’t make the same mistake twice.”
Rejections happen. They can be resolved.
Recurring rejections, however, are not acceptable.
After identifying an issue, your medical billing service should do the following:
Identify patterns of recurring errors quickly
Pinpoint the exact source of the issue with the rejected claims
Work with your office staff and/or clearinghouse to create workflows to correct potential errors
This is an area in which many medical billing services fall short.
Especially larger companies & budget-priced services.
Usually only a smaller, dedicated billing service will have the bandwidth to resolve complex issues.
This is because billing issues are often traced to failures of communication - whereas in a smaller company, communication is easier.
Which leads us to question #3…
Question 3: “How will you communicate with my office?”
When you have a billing issue, you need action.
Quickly.
You don’t want to be put on hold, directed to call someone else, given different answers from different people, etc.
If you have an issue, you need quick response and complete resolution.
The key is clear, predictable communication.
Here’s what you should look for:
Key response #1: “You have a dedicated manager who is responsible for your account.”
If you have question, you need to know who to ask.
Otherwise, it’s hard to find answers.
Remember how 85% of medical billing issues begin in the physician’s office?
Your medical billing service must communicate with your office staff all the time!
That’s why you need a dedicated contact at your medical billing service.
Larger companies tend to have multiple managers responsible for your account - so it’s hard to resolve problems quickly. This leads to delays in resolving issues with claims, which in turn means lost revenue for you.
Clear, efficient communication with your office - via a single contact person - solves that.
But communication with your office is only the first step.
Which brings us to the next point…
Key response #2: “Your manager communicates directly with every person who works on your account.”
Information must be used. Otherwise it has no value.
In a larger company, where each stage of the billing process happens in a different “silo,” information gets lost.
We’ve seen it many times.
That’s why you need a dedicated billing team focused on your account.
Things don’t get lost.
Your revenue increases.
Next steps
Remember: you don’t have to be an expert in medical billing.
You just have to recognize expertise.
Does your medical billing service measure up?
If you have questions, let’s talk.
We offer a free revenue analysis to help you understand your current billing situation: