Many providers today choose to outsource their billing. The billing process has become much more complex in recent years and for many it makes sense to outsource it. Between software updates, required electronic filing of claims, NPI numbers, and other changes, it has become almost impossible for vendors to keep up.
However, if you’ve only used one biller or billing service, you might not know exactly what to expect from them. Providers using other services sometimes ask us, “Should my billing service do this for me, or do I have to do it in my office?”
It’s good to know exactly what your billing service is supposed to do and what your office is responsible for. This 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 is doing and it works for you. We actually offer different services for different accounts depending on the needs of the office. For example, we don’t usually get involved in obtaining permits, but we have a few clients who can’t manage to get them from their office, so they pay us extra to do it for them.
But there are some things that all billing services should handle. Settlement isn’t just filing insurance claims and waiting for payment. A good billing service submits claims electronically whenever possible, reviews electronic reports for rejections and bad batches, and follows up on unpaid claims. You should also take care of rejected claims.
If they don’t check electronic reports and do regular follow-ups, you’re losing money and so are they. Electronic reports alert you when there are problems with one of your claims or entire batches. If you don’t read them, you won’t fix these problems. For example, an electronic report returns a claim if the ID number is incorrect. Maybe it’s a simple typo, two numbers got mixed up, but failing to read the electronic reports could be a big problem. What if it is a patient who comes once a week? None of the claims go through because the ID number was not set.
Many insurance carriers now have deadlines for submitting applications. Some are very short, like 60 days from the date of delivery. Failure to follow up regularly can result in lost money from timely filing. Follow-up reports should be made every 4-6 weeks and all claims over 30 days should be reviewed.
There are other things that billing services can do to keep your accounts receivable running smoothly, but those are the basics. If you feel that your accounts receivable is not what it should be, you should meet with your billing service and ask what can be done to improve the situation. Tell them you want a report on your claims. What are your numbers over 30 days, over 60 days? They should be ready to provide you with reports on what’s pending and why, and it shouldn’t take them more than a few days to provide the reports. If they don’t want to provide you with this information, you need to consider why.
I’m not trying to betray anyone. 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 about poor service and this makes vendors suspicious of outsourcing when it’s a viable option.
Copyright 2008 – Michele Redmond – Solutions Medical Billing Inc