What Makes a Great Medical Biller?
It can be so difficult to find a good medical billing professional. As a physician, you know how critical a skilled medical biller is to your cash flow. They are the bloodline to your business.
If you’re lucky, you have a biller who’s been with you for decades – they know your practice, your methods of testing, and the two of you can communicate frequently and clearly.
But not all physicians have that luxury. Some are just starting in their practice, and may not be able to afford a full-time employee. If you are a surgeon or anesthesiologist, it makes hardly any sense to keep one in-house, given your need to keep low overhead. In these cases, the billing duties are split between employees, and ultimately costing the practice money. Not to mention costing you time in doing what you set out for – practicing medicine.
It’s not choosing a medical biller that’s the problem, though – it’s finding one to begin with. The shortage in the industry was at 30% before, and has increased since.
Not to mention, medical billing is one of those professions with a huge discrepancy between ‘capable’ and ‘effective’. With the ever-changing regulations, and the inherent complexity of the job, it can be near impossible to find a medical biller that ensures the trust and skills needed for your practice to thrive.
So, whether you’re looking for your first time or unsatisfied with your current services, we’ve laid out the things you should be looking for in your search for your next great medical biller:
Insurance companies only give you a certain amount of days to file your claims. Once that’s exceeded, you are unable to appeal a denial.
What’s trickier is when insurance companies miss a service—even when it’s sent on time—and it leads to a denial. This can happen when services are sent in a batch – for example, five services may be sent at the same time, and for some reason the third service is skipped and unpaid by the insurance company.
A great medical billing company will have detailed records of when services were sent. If proved accurate, that denial will be appealed, and the money will be paid. Most billing companies use a clearinghouse to do this, which ensures accuracy most effectively.
In deepest accountability, a medical billing company will guarantee to pay the claim themselves, if it’s lost to billing error or untimely filing.
Following Up On Denied Claims
Insurance companies are notorious for denying claims, and they have various means for doing so.
The problem is that the medical biller/company is sometimes not tenacious enough in their follow-up. Perhaps they will submit an appeal, receive another denial and then back off.
The great medical billers/companies will appeal three, maybe even four times—rather, as many times as they need to—when they know the claim should be paid. In this rigorous follow-up, according to an anonymous, professional biller, the claim is paid almost 90% of the time.
Steady Communication with the Provider
The provider and billing company must be completely in-step when it comes to logging and compiling a medical bill. As you know, each patient visit requires medical code for the procedures performed. Billing software is becoming more capable of expediting this, yet it still requires daily checking and maintenance from the billing company.
With electronic record-keeping, it’s critical that the billing company has top-notch data security, information-sharing policies, recovery procedures, and data backup. This is especially true given the increase in data hacks.
Steady communication also involves keeping up-to-date with the contract between the provider and the insurance company, including billing compliance with the requirements of HIPAA.
Current With Latest Industry Developments
A medical billing professional needs to be re-certified every single year. In comparison, nurses and x-ray technicians need re-certification only every other year. This shows how quickly the regulations in medical billing can change.
The commitment needed to stay on top of regulations and developments is in itself a full-time job. This is especially true since the transition to ICD-10 coding. A great medical biller can seamlessly work between the ICD-9 and ICD-10 codes.
Experience in the Industry
The proverbial ‘unicorn’ in medical billing is one with the technical/coding expertise as well as a background in medicine. This way, the biller will know which procedures are covered, a huge advantage when submitting claims.
Experience here also refers not only to years in business, but familiarity with particular specialities. If you can find a medical biller with knowledge of your specialty, this is a huge plus.
You will also want a person or company that has plenty of coding experience. To teach someone from scratch is almost impossible. Medical coding is a different language, and overwhelming to someone without prior experience. The cost of a coding mistake is too great—in both time and money—to leave in the hands of someone without proper experience.
Will They Fight For You?
This is ultimately the bottom line.
Your medical billing company needs to have your trust that they will do everything they can to ensure you are paid for what you do. And, as one who is saving lives, you need the peace-of-mind that your back-end work is being handled efficiently and accurately.
This is one of the most important relationships in running your practice, and not a decision to be taken lightly.
MBA has been in business for over 20 years. We are committed to being the best in the industry, that’s why our average number of days in A/R is nearly half the industry average. We work in a variety of specialties and can develop solutions customized for your practice.
Call us today at MBA Medical if you have any questions – we’re happy to help!