Many providers today are choosing to outsource their billing. The billing process has become much more complicated in recent years and for many it makes sense to outsource. Between software updates, required electronic filing of claims, NPI numbers, and other changes, it has become nearly impossible for providers to keep up.
However, if you’ve only used one biller or billing service, then you may not really know what to expect from them. We have vendors that use other services that sometimes ask us “Should my billing service do this for me or is this something I have to do in my office?”
It’s good to be clear about what your billing service needs to do and what your office will be responsible for. That way you can keep things running smoothly. Not all billing services do things the same way and that’s fine as long as you know what yours does and it works for you. In fact, we provide different services for different accounts depending on the needs of the office. For example, we don’t normally get involved in getting clearances, however, we have a couple of clients that can’t handle getting them from their office, so they pay us more to do that for them.
But there are a few things that all billing services must handle. Billing is not just the act of filing insurance claims and waiting for payment to arrive. A good billing service will file claims, electronically whenever possible, check electronic reports for denials and defective lots, and follow up on unpaid claims. They must also handle any denied claims.
If they don’t check the electronic reports and follow up regularly, you’re losing money and so are they. Electronic reporting will notify you if there are issues with any of your claims or entire batches. If they’re not reading them, then they’re not fixing those problems. For example, an electronic report will return a claim if the identification number is not correct. Maybe it’s a simple typo, two numbers transposed, but if the electronic reports don’t read, it could be a big problem. What if it’s a patient who comes in once a week? None of the claims are ongoing because the identification number was not set.
Many insurance companies today have long filing deadlines. Some are very short, like 60 days from the date of service. If regular follow-up is not done, money can be lost due to timely filing. Follow-up reports must be run every 4-6 weeks and all claims older than 30 days must be verified.
There are other things billing services can do to keep your accounts receivable running smoothly, but those are the basics. If you think your accounts receivable aren’t what they should be, you might consider meeting with your billing service and asking what can be done to improve the situation. Tell them you’d like a report on your accounts receivable. What are your figures at 30 days, at 60 days? They should be willing to provide you with reports of what’s pending and why, and it shouldn’t take more than a couple of days for the reports to be available. If they are not willing to provide you with this information, then you need to consider why.
I’m not trying to rat anyone out. I’m just trying to hold us all accountable for providing the best possible service so billing services don’t get a bad rap. We hear too many stories of poor service and it makes providers wary of outsourcing when it is a viable option.
Copyright 2008 – Michele Redmond – Medical Billing Solutions Inc.
