In California, physicians face challenges such as underperforming accounts receivables (AR) and claims denials. It's also difficult to keep a track and abide by the constant changes taking place in the healthcare legislation. This is where the expertise and experience of medical billing companies can be of immense help. The Bureau of Labor Statistics projects that the outsourced medical billing industry will grow by more than 20% over the next decade.

Outsourcing your billing services will manage the AR. Billing professionals capture denials and accurately report the explanation of benefits (EOB) information. This results in a significant drop in the processing time.

Outsourcing to a medical billing service is more cost-effective compared to running an in-house billing team. Here are a few key points to keep in mind while outsourcing your medical billing services in California.

Industry Experience and Training

While choosing a medical billing service in California, inquire about the company's and staff's background and experience in billing and coding. Check the company's familiarity with certain specialties since billing procedures will vary by medical specialty. Ensure their professionals are updated about new standards in the industry. Check for the company's credentials and the type of education their employees have received.

ICD and CPT Codes

Medical billing companies facilitate transition to new coding standards, like the ICD-10 in recent times. Their professionals are informed about the latest industry regulations, procedures, and the annual updates on ICD and CPT codes. They should be trained on the 2015 CPT code updates and should ensure smooth transition to ICD-10 codes.

HIPAA Compliance

It is critical to know if the company is HIPAA-compliant. Inquire what procedures are in place to adhere to the regulations. A lack in security of patient data can result in audits and land you in trouble. HIPAA 5010 enables improved data and provides the foundation for ICD-10 medical coding standard. It will also impact some features of HIPAA regulations in a more significant manner.

Payment Posting

A team of highly skilled staff will take care of timely and accurate posting of all payments from EOB, correspondence and contractual adjustments. This allows for the efficient use of AR and follow-up staff. Payment posting not just entails posting payments but also involves posting adjustments and denials. Inaccurate payment posting affects the accuracy of claims submissions to secondary and tertiary payers. If the primary payment is posted incorrectly, there's a possibility that the secondary and tertiary payers will also get billed out incorrectly.

AR Follow-Up

Accurate and timely submissions of medical bills and claims increase the number of medical reimbursements. A professional billing service accurately enters the charges and files claims on time. Many claims are rejected because of errors in coding. Ask the billing company about their procedures on AR follow-up, claims denials, appeals, resubmissions, and secondary and tertiary claims. If you practice a particular specialty, it is ideal to have a billing company particularly knowledgeable about your specialty.

While selecting a medical billing service in California, ensure the company you choose fulfills the prerequisites listed above. Billing partners like are equipped with the demands of ICD-10 coding and HIPAA 5010 medical reporting compliance. Their billers can apply standard CPT, HCPCS procedure and ICD-CM diagnosis coding as per the Centers for Medicare & Medicaid Services guidelines. A dedicated billing and coding team ensures filing timely claims, managing denials, following up with insurance companies and other related tasks.

Published By - Medical Billers and Coders
Published Date - Mar-09-2015 Back

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