Expectations of Physicians from Centralized Medical Billing Company

January 20, 2017


Medical Billing plays a very important and deciding role in prospects of a practice. The fact of the matter actually is that it is the medical billing company that is powerful enough to make or break the income of a practice. Physicians, surgeons and ASCs need to be careful while choosing their billing company. Even before actually signing on the dotted line, physicians need to be clear about what their exact needs are. Would you really want to outsource or rather have an in-house medical billing expert? There is no doubt that outsourcing has its own merits, and here are a few strong reasons why physicians are better off outsourcing, and what they should expect from a Centralized Medical Billing Company.

The first thing a physician would want to know would be how they would go about streamlining the entire billing process with the physicians and how exactly the coding process works. Although coding is the bounden responsibility of the physicians, a professionally managed medical billing and coding company should be familiar, rather thorough with all aspects of coding and the issues involved, and have a hawk's eye that spots errors and advises the physicians about the best practices.

Physicians expect to know about the follow up on claims. They are also anxious about what sort of appeal system would be deployed to ensure the claims are not denied and pass through smoothly. The people in charge of processing the claims need to realize the importance of follow up, and that appeals need to be doggedly followed up. Not all the medical billing companies are up to the cumbersome task of following up and ensuring claims do not end up with denials.

Most of the companies today rely on software, hence physicians expect to be informed about the efficiency of the software being used, and what sort of reports would be generated and submitted periodically. Apart from wanting to know the frequency of the reports (annual, half-yearly, quarterly, bi-monthly etc) they are also curious to know how flexible they are about reports on demand. Posting Accounts Receivable (ARs) and Accounts Payable (APs) regularly helps the physicians know where exactly the practice stands, and can get a fair idea about how healthy the collection percentages are.

Physicians would certainly expect to know how up-to-date the companies are in coding for the year, and whether they are using a comprehensive coding software. Outdated books or software on coding may not be of much use to physicians who expect more descriptive details on recent code changes and updates.

Employees given the tasks of billing and coding need to also realize that physicians are anxious to learn about the collection practices and procedures adopted by them. They would like to know if the people they are dealing with provide soft collections, and give periodic alerts on such accounts that need monitoring and follow up. Moreover, physicians also expect to be updated periodically about issues with claims, and how the company proposes to resolve such issues.

Physicians also expect to be able to reach a responsible staff member in the company, and would expect to know when a call is likely to be returned in a 24-hour frame. Most companies do not work 24/7 and have fixed office hours. Especially, companies that operate in different time zones need to ensure that agents are reachable during convenient time slots for physicians to answer questions and resolve issues.

Finally, physicians certainly expect to know what the costs involved are going to be. There is no point in outsourcing to a frightfully expensive medical billing company as the physicians would rather process the billing and coding in-house if the economics of outsourcing are not favorable. Details of whether the charges are calculated on percentage basis or flat charges based on the number of hours worked are some questions that physicians would want upfront answers. If there is a start-up fee involved, physicians expect to be informed about that as well, as also the nature of the contract and the period of validity


Category : Best Billing and Coding Practices