Wisely Choose Your Orthopedic Billing Partner

Outsourcing is Need of the Hour

Nowadays, most of the practices feel comfortable passing the burden of billing and coding onto medical billing partners. Billing companies have medical specialty-wise billing and coding experts who streamline the revenue cycle process for healthcare practice. But not all medical billing companies are the same, some of them may not have RCM experts or processes. Choosing the wrong billing service or outsourcing for the wrong reason can quickly become a risk and lost revenue nightmare. Hastily outsourcing billing and collections without careful evaluation of the company could lead to severe problems in long term. Performing due diligence before signing a contract with such companies can mitigate risk and performance issues before they become unmanageable. Consider this article, as a guide to choosing your orthopedic billing partner.

Wisely Choose Your Orthopedic Billing Partner

Business Associate Agreement (BAA)

Fewer service rates are the only selection criteria of most orthopedic providers. Many small medical billing companies process a claim but they are unaware of the regulatory environment or the insurance compliances. Such billing companies have no privacy, security, or document destruction policies, and may not even know what a Business Associate Agreement (BAA) is, let alone supply one to the practice. When you are entering into a contract with medical billing company ensure that your BAA includes, a security policy, a privacy policy, and have a breach notification procedure in place and ready in case a breach occurs.


Medical billing has been widely affected since the HIPAA Omnibus Rule was introduced in 2013. All parties involved in managing patient health information (PHI) are now required to have rigorous privacy, security, and breach procedures. Practices should draft and scrutinize the BAA carefully and ask specific questions about the security policy for electronic communication. Note that, if the billing service doesn’t shred accounts receivable reports or paper Explanation of Benefits, and these fall into the wrong hands, the practice may still get fined. The billing service’s security policy should cover the details of protecting both digital and paper personal health information (PHI).  Practices should check about privacy policies and procedures in the billing company. Who has access to confidential patient data and for what reason? Do employees use computer privacy screens? Do electronic systems log people off after approximately 10 minutes of inactivity?

Billing Expertise

Don’t assume that the billing company’s employees have up-to-date knowledge of coding rules or Federal regulations. To provide a more economical deal, billing companies might assign lesser experienced billing experts for your account. Billing companies might fall short when it comes to training. Employees don’t attend annual society coding workshops. Their employees may rely on ‘years of experience and advice from online coding discussion boards. An uneducated workforce is dangerous. If billing service employees are not receiving ongoing education, they may not know regulatory rules or use best practices for managing accounts. The billing service employees should attend coding courses each year. Practices should also expect the service to be competent with ICD-10 coding and aware of fraud and abuse statutes.

Billing Reports

You should ask for various billing reports which give an overall picture of your collection activities. To determine whether the service uses effective accounts receivable processes, orthopedic practices should ask how unpaid, underpaid, and denied claims are handled. Ask for AR aging, rejections, payment trends, and overall collection report. Reputable billing companies have procedures for every medical billing process. Request copies of billing and collections procedures, and sample reports. Ask for protocols describing how credit balances, refunds, and adjustments are handled and modify these procedures for your practice. You also need to clarify that the service will never change a diagnosis or procedure code for any reason without physician approval.

Before outsourcing orthopedic billing and coding services, practices should carefully evaluate the billing company to minimize risk and lost revenue. Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. Our HIPAA-compliant billing services, industry presence of 15+ years, and a team of industry-best coders and billers make us a trusted orthopedic billing partner. To know more about our orthopedic billing services, contact us at: 888-357-3226 or drop an email at: info@medicalbillersandcoders.com.