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  • Writer's pictureMuhammad Sair Khan

7 Things to Look For in a Medical Billing Company

Updated: Dec 1, 2022

Outsourcing or changing billing companies can be a lot of work. In fact, many providers stick with a mediocre billing service simply to avoid the work that goes into the transition. Additionally, because many medical practices depend on insurance reimbursement to stay in business, the fear of making a switch that will harm revenue overrides the desire to generate more.

There are many things to consider when interviewing a medical billing company. To save you time, we outlined the most important questions to ask and variables to consider before making a switch.

1. Accessibility

Don't underestimate the importance of first-class customer service. Do you have a single point of contact, and when you have a question how long does it take to get a response? Will you have a regular A/R meeting to discuss open claims, monthly statistics, and financials?

2. Industry Experience

Changes in the medical community happen constantly. You want to work with a billing service that is always on the look-out for updates in coding and insurance requirements. Is your billing company involved with medical billing organizations? Do they attend local and national seminars? Is their staff certified in medical billing and coding?

3. Billing Software

There are many EHR systems on the market. You should know what software your billing company uses and ensure that it provides all of the integrations and functionality that your facility relies on.

4. Analytics and Financial Reporting

Analytics and financial reporting is critical to all businesses, especially medical practices. Do you have access to payment trends by policy ID number and CPT code?

Other important statistics include the total dollar amount billed versus the total amount collected each week, average claim turnaround time, and percentage of reimbursement by payer for all levels of care.

5. VOB Verification

Because insurance billing is increasingly scrutinized by insurance providers, it is important to choose a company that will give you a fast and accurate turn-around-time for VOB’s. If not, you risk admitting a patient into your facility that does not have proper coverage for the treatment you provide.

6. Code Billed Vs. Reimbursement Rate

There are different codes for all medical procedures. Some codes pay higher than others -- even if the service is exactly the same. Further, a code that Blue Cross pays at a high reimbursement rate, Aetna may not accept at all. Insurers constantly change coding requirements, so choosing a billing company that stays up-to-date with industry trends is crucial.

7. Appeals

Does your billing company submit appeal letters? Claim denials are inevitable so you want to partner with a billing company that won't give up when your claims aren't easily reimbursed. If a claim requires an appeal letter, does your billing company seek out legal advise? If they do seek out legal advise, will there be an additional fee charged to your company for doing so? At Datapro Services, we appeal claims all the way up to the state level at NO ADDITIONAL CHARGE to you or your company.

Finding the right billing service will tremendously improve your daily workflow, and increase your revenue.

For an insider's guide to accurate claims processing, download our 'Behavioral Health Guide to Quick and Accurate Claims Processing'

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