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Medical Billing Services: Our Recommendations for 2016

Medical billing is a central pillar of any health care practice. Although care is the top priority, your practice is still a business. To make sure you're actually getting paid for the services you provide, you'll need a knowledgeable, focused and reliable team overseeing your billing. From coding and processing claims to dealing with insurance companies and chasing down unpaid patient accounts, a billing department needs to be on the ball. As the leader of a small or midsize medical practice, you have one big determination to make right off the bat: Do you keep billing in-house or outsource it to a professional company?

The first major question to address when it comes to medical billing is whether you want your staff to conduct the billing process or outsource it to a medical billing service that specializes in revenue cycle management.

If you opt to have your own staff cover medical billing, you'll need practice management software to keep track of your patients' balances and send bills to payers. You'll also need a certified medical coder on staff to oversee the operation, and the practice will be responsible for responding to any rejections or denied claims.

It's also crucial to stay on top of the ever-changing regulatory framework and new policies, such as the transition to the more complex ICD-10 coding that took place in October 2015. Keeping billing in-house is often cheaper and gives you more control over the process, but for a small practice that already needs its staff to wear many hats, billing can be time-consuming and complex. Worse yet, if the proper time and attention are not given to the billing process, you might end up losing out on a substantial amount of money.

Medical billing services can help alleviate that burden, but it might end up being more expensive. Often, for a percentage of your collections or a subscription fee, a medical billing service can take over your revenue cycle management and free up your staff to focus on other tasks. A good medical billing service will increase your collection rate, reduce rejections and denials, and even provide an analysis of your accounts receivable. You'll typically be able to generate on-demand reports and view your day-to-day finances through the company's software as well. At best, outsourcing your revenue cycle management can result in more money for your practice without allocating your own staff to complete the arduous tasks of coding and billing. But how can you possibly know which billing service to trust with something as important as your revenue cycle management?

Editor’s Note: Looking for an medical billing service? If you’re looking for information to help you choose the one that’s right for you, use the questionnaire below to have our sister site, BuyerZone, provide you with information from a variety of vendors for free:

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There are literally hundreds, if not thousands, of medical billing services to choose from. Some are large companies with a plethora of resources, while others operate out of living rooms, according to Susan Montana, a certified health care technology specialist and trainer with Habanero Inc.

"It's one of those things where you have to weigh the pros and cons," Montana told Business News Daily. "The first thing to do [when outsourcing] is to contractually understand what it is you'd be getting for your money. So many people get involved with these billing services, and it's not really specified who is responsible for doing what."

Outsourcing your medical billing is a huge decision with potentially far-reaching financial and legal implications. So, Business News Daily interviewed medical billing experts and reviewed some of the major players in the industry to find out what you need to know about choosing a medical billing service.

When selecting a medical billing service, there are a few things to keep in mind. Of course, you'll want to know what the costs of the service are, but you'll also want to know exactly what you can expect from a billing partner.

"Your lifeblood as a medical practitioner resides with this function," Montana said. "If medical billing isn't working, not only are you not getting paid, but you won't make payroll, and you can get in so much legal trouble with the insurance companies. You need to know what you're getting."

That can be difficult, according to David Zetter, founder of Zetter Healthcare and a member of the National Society of Certified Healthcare Business Consultants. Without knowing the right questions to ask, a practice can wind up working with a medical billing service that doesn't live up to its promises. Luckily, we found out from several experts what the most important things to ask are before you agree to outsource your medical billing with a particular company.

"A lot of times, practices that have never done billing in-house don't know anything about [revenue cycle management], so they can't know what they're really getting," Zetter said.

Zetter recommended hiring a professional consultant with extensive experience to help guide your practice. You can locate a professional consultant here. But if you decide to go it alone, there are a few questions that should be on your mind when selecting a medical billing partner. Here are a few aspects to consider before buying:

These are highly variable based on the size and specific focus of your practice. You'll need to contact a sales representative for hard numbers, but some billing services' websites offer a general estimate of what they charge. Companies most commonly charge a percentage of your monthly revenue as payment, often between 4 and 9 percent. It's important to consider what the costs in time and money would be to keep billing in-house versus what the financial cost would be to outsource relative to the potential increase in revenue. Here are three key questions to ask a medical billing service when discussing costs:

  1. What specific services are included in the monthly percentage I am paying?
  2. Are any clearinghouse fees included in the percentage, or are they additionally charged to my practice?
  3. Does the percentage include any co-pays my staff collects at the time services are rendered?

Most billing companies will scrutinize your claims for errors before processing them, and many follow up with the insurance company to ensure the claims are accepted. However, some companies will also provide a periodic analysis of your accounts receivable, along with recommendations on how to improve your practice's financial performance. Others even come with access to an electronic health records system and/or practice management software. When you're determining which company to outsource your revenue cycle management to, it will be important to consider which services your practice and patients need. You'll also want to consider the following:

  1. Does the medical billing service have certified coders on staff, or will my practice be responsible for coding?
  2. If the billing service does perform coding, is it up to date with the transition to the more robust ICD-10 coding system?
  3. How detailed are the financial reports from the medical billing service? Can my practice expect analysis and suggestions to improve performance?
  4. Does the medical billing service have experience with billing for my specialty?

Because your practice's financials are tantamount to its success, you'll want a communicative billing partner that keeps you engaged at every turn. Most companies offer software that allows practices to regularly review their revenue cycle, claims and rejections. You'll want to ensure that, in the event something goes wrong, your medical billing partner will be responsive and helpful. Open lines of communication can mean the difference between a breakdown in the billing department and a boost to your bottom line. It's important to ask the following questions before signing on the dotted line:

  1. Can I access information about my practice's revenue cycle at any time?
  2. What can I expect from the medical billing service when a mistake is made?
  3. Will the billing service provide my practice with copies of any "explanation of benefits" or "electronic remittance advice" documents it receives from payers?

A medical billing service should also keep your patients in the loop and deal with delinquent accounts. Many billing services will send patients their statements directly and transfer unpaid accounts to collection agencies if necessary. Some medical billing services field phone calls and address patient questions as well. Some companies even offer a patient portal, where patients can directly access and pay off their accounts. You'll want to be sure your medical billing partner is willing to stay engaged with your patients and keep them abreast of what they owe. You'll also want to find out the following:

  1. How long will the billing service wait to transfer unpaid balances to a collection agency?
  2. Is a patient portal included in my monthly percentage, or is it an additional cost?

Most companies offer either cloud hosting or will host the software and your data on their own servers. This service will keep your practice from needing servers of its own, which can be costly to keep and a risk to your practice's data if something should happen to any of the hardware. Instead, remotely hosted medical billing services take care of updates and system maintenance on their end, removing one more thing from your staff's to-do list.

Both Montana and Zetter said it's important to check the billing company's references and spell out in a written agreement exactly what services the company will be providing, and for what costs. In addition, they both suggested obtaining written confirmation of what you can expect from a billing service when something goes wrong.

"Find out [from other clients] what mistakes the company makes," Zetter said. "If they tell you they don't make any, that's not true. Everybody makes mistakes in billing, but the key is how they handle those mistakes."

Also, check to be sure the medical billing service you are considering has experience with billing for your specialty; an emergency room doctor's billing needs, for example, will be vastly different from an oncologist's. Ensure your medical billing partner knows the ins and outs of your specialty.

"It comes down to the expertise of the organization that you're working with," said Jonathan Doctor, managing partner at Denovo Health Partners. "Do they have the depth and breadth of knowledge in the related specialty? Every specialty has different parameters and different levels of understanding and complexity."

And remember: Choosing a medical billing partner shouldn't be taken lightly. This company will be in charge of your revenue cycle management, meaning that there isn't only money at stake, but also legal liabilities to consider.

"You, as the provider, are on the hook for whatever they do, so if they make a mistake, it's considered your fault," Montana said.

Are you ready to outsource your medical billing? We gathered a few recommendations, but remember, every practice's needs are different. Make sure you specify all of your wants and needs and receive written confirmation about each service the company says it will provide.

To determine our recommendations for medical billing services, we began with a list of 50 major companies in the revenue cycle management space. After some early research, including viewing other best picks lists and conducting interviews with medical billing experts, we narrowed down the list to 21 companies that stood out from the rest.

Next, we researched each provider by analyzing the services it offered, viewing its website, watching videos, and reading reviews and comments. We also considered pricing when available, although it is highly variable from practice to practice. In addition, we contacted each company's customer service department by phone and posed as a new practice to estimate the level of support each company offers.

Because there are so many medical billing services, and needs vary among practices, we elected not to choose the "best" billing service. Instead, we chose to offer a list of recommendations for medical providers to use as a reference when researching medical billing services. We narrowed down our list to 14 companies by analyzing each of the following factors: estimated costs, services offered, specialty experience, reporting/analysis capabilities, training and implementation support, patient engagement, remote hosting and customer service.

Here are some reputable companies you might want to consider researching:

ADP's medical billing service includes implementation managers to help familiarize your practice with the process of outsourcing. The company says that 95 percent of the claims it submits will be accepted on the first pass, with the help of a claims center intended to thoroughly scrub for coding and other errors. Through its "AdvancedInsight" reporting system, practices have access to analyses of their finances and revenue cycle. There are no startup fees and the service itself generally costs about six to eight percent of your monthly revenue stream.
advancedmd.com

The Athenahealth billing service, known as athenaCollector, employs a "rules engine" that identifies and flags common mistakes made across all of the company's clients. That system contributes to athenahealth's 94 percent first-pass claim rate. There are no startup fees, but the monthly percentage can vary greatly depending on the size and type of your practice. In addition, you have to commit to athenaCollector for a minimum of 90 days once your practice signs up.
athenahealth.com

Care360's staff includes certified coders and billers whom can manage every phase of the revenue cycle. The company also offers a billing dashboard that gives you full access to your practice's financials at any time. When you outsource with Care360, they provide a "customer success coach" to help familiarize your staff with the outsourcing process and show you how to stay informed as they manage your billing. Contact a sales representative for more information about pricing.
questdiagnostics.com

ClaimCare promises to reimburse your practice if it misses a submission deadline. The company also claims that it will resolve 95 percent of your practice's claims in the first 120 days of managing your revenue cycle. ClaimCare also offers front-desk training, an electronic health record system and a practice management system. ClaimCare's customer service and support department was satisfactory in our experience.
claimcare.net

Clinical Info Solutions offers two options for outsourcing your billing. The company is able to remotely access your practice management system and conduct billing operations, storing the data on its own servers. They provide billing management at all levels of the cycle, from insurance verification to collection agency referrals. There are no startup fees, but you do have to give a 30-day notice if you plan to cancel the service.
clinicalinfosolutions.com

CRT offers full management of your revenue cycle or a hybrid service that allows you to keep some of your billing operations in-house. CRT will produce financial reports for your practice on a weekly or monthly basis, as well as perform a free practice analysis when you begin working with the company. Costs vary based on which service you select, as well as on your practice's size and specialty.
crtmedical.com

GroupOne maintains a staff of certified coders and billers and promises a 97.5 percent first-pass claim rate. The company interfaces with eClinicalWorks electronic health records system and offers services from coding review to claim follow-up. Prices vary greatly based on the size and type of your practice, so you'll need to contact a sales representative for more details.
grouponehealthsource.com

InSync HCS is a multi-specialty company that offers revenue cycle management, as well as electronic health record systems, practice management systems, and medical transcription services. All of InSync HCS's solutions are cloud-based and intuitive to navigate. http://www.insynchcs.com/

iSALUS is focused on small and medium-size practices. The company offers a wide range of services, including insurance verification, custom financial reporting and denial appeals. iSALUS also offers a free electronic health records system, as well as personal demos upon request. There are also technology consultants on staff with iSALUS to help your practice navigate the evolving world of medical technology. Our customer service experience with iSALUS was satisfactory.
isalushealthcare.com

Kareo promises robust reporting and analysis of your practice's financials. There are no startup fees, and the monthly cost to outsource with Kareo averages about 4 to 9 percent of your revenue. Kareo utilizes a billing rules engine that automatically flags any issues with a claim to ensure the problem is resolved before the claim is submitted to the appropriate payer. You can discuss your practice's specific needs and options with a specialist when requesting a quote.
kareo.com

Medical Billing Professionals offers various specialized services, including medical billing tailored to chiropractors, physical therapists and mental health professionals. The company charges a flat fee, rather than a percentage; its premium billing service can be prepaid for as little as $1.55 per claim, while its PremiumPlus service starts at $1.99 per claim. Depending on the plan you choose, Medical Billing Professionals can offer a full and complete service, including robust reporting and experience in a variety of specialties.
mbpros.com

PracticeForces' staff includes certified coders whom have access to a real-time database of payer rules and regulations, helping them to keep up with regulatory changes as they happen. The company also says it will scrub and electronically submit any claims within 12 hours of the patient visit and will provide verification of the claim's status within 48 hours. PracticeForces promises at least a 95 percent first-pass claims rate.  
practiceforces.com

Precision offers several options for outsourcing your billing. Your practice can hire them to manage the entire process or just one part, like coding, for example. Precision will create custom financial reports for your practice and has experience billing for dozens of specialties as well. However, the cost varies dramatically based on the services your practice requires, and you'll have to contact a sales representative for more information.
precisionpractice.com

ProMD guarantees collection rates of between 90 and 98 percent. The company offers services ranging from claims processing to denial appeals, as well as provides a practice management system for free. In addition to revenue cycle management, ProMD offers practice consultation services and a financial analysis to offer your practice recommendations on how to improve performance. You will have to contact a sales representative to obtain a price quote.
promd.com

Are you a medical billing service who would like to be considered for our next round of reviews? Please feel free to contact Adam C. Uzialko at auzialko@purch.com.

Editor’s Note: Looking for an medical billing service? If you’re looking for information to help you choose the one that’s right for you, use the questionnaire below to have our sister site, BuyerZone, provide you with information from a variety of vendors for free:

buyerzone widget
Adam C. Uzialko

Adam received his Bachelor's degree in Political Science and Journalism & Media Studies at Rutgers University. He worked for a local newspaper and freelanced for several publications after graduating college. He can be reached by email, or follow him on Twitter.