The key to increase financial growth of an outsourced medical billing service

Outsourced Medical Billing

Practice management in medical billing is to shift the heavy lifting around getting paid, so that the physician or healthcare provider, who outsourced medical billing, can focus more on patient care and worry less about collections.

We can increase physician’s revenue by handling following medical billing functions on his behalf:

  • CLAIMS SUBMISSION – Getting claims to payers promptly, whether electronic or paper.
  • PAYMENT POSTING –Posting of all electronic & paper remittances, resulting in accurate aging reports of your account receivables
  • INSURANCE FOLLOW UP –re-work and/or appeal denials and follow up on claims without responses
  • PATIENT STATEMENTS –As part of monthly closing activities, patient statements can be prepared and submitted through the clearinghouse for mailing or you can batch print patient

Tracking medical billing performance is very challenging for healthcare organizations especially for smaller practices, it also cost much more than outsourcing. A medical billing professional will invest time and resources to do this and track your business financial health by following matrices:

  • Gross Collections Rate –This matrix tells the percentage you’ve collected of what you’ve Charged.
  • Net Collections Rate – This important matrix needs to be tracked over time because it will give you a good idea of how well your practice is at collecting money that you’re owed.
  • Days in A/R Ratio – The Days in A/R (Accounts Receivable) Ratio tells you that how long it takes to collect payments. Days in A/R should be less than 30 for basic services if your are doing a good job in collecting payment. If it’s above 40 or 50, then you have a serious issue with your collection process.
  • Denial Rates – Denial Rates should be low as they can greatly affect your A/R levels and can result in delayed payments. If your denial rates are high, then something needs to be changed in your medical billing process.

Poor billing performance will result in a loss in profit, so not only evaluate medical billing performance but also help to improve it by ;

  • Improving your record-keeping and assessment
  • Improving your collections techniques
  • Providing operational oversight
  • Providing better practice management software

Best Practices to Ensure Prompt Claims Payment

“The longer a claim goes unpaid, the higher the chance that it won’t get paid.“

Following some smart practices in claims workflow can go a long way towards minimizing such situations because it is always best to avoid getting into situations where extra effort is necessary to ensure payment:

  • Daily charge posting

To avoid problems and improper charges avoid infrequent and irregular charges posting. The minor extra expense of daily charge posting will be far outweighed by the problems it avoids.

  • Daily claims filing and submission

Claims should be submitted promptly every day. When it is possible to prevent delays in payments then why to take risk with irregular submission? Only submitting claims once a week is another practice which saves pennies, but frequently loses dollars.

  • Ensure the use of electronic submissions

This is excellent If you are submitting 100% electronic claims. But if it is not so then go through your records of payers, looking for situations where you are still using paper methods even though they accept electronic submissions. To stay on paper has no advantage rather this process is a slower and more prone to error.

  • Institute a claim editing engine

Modern claim processing software can go a long way towards streamlining your operation because a claim editing engine allows for faster editing of improper submissions and can usually be configured to incorporate other critical pieces of information.  For example, have listings of filing deadlines for all payers, so that any claims nearing the deadline get flagged.

  • Investigate the root causes of claim edits

Addressing the issues, like, if claim edit is needed then you should drill into root cause of it and optimize the problematic areas in workflow. Don’t let these go investigated, it will reduce your claim edits overall.


Please enter your comment!
Please enter your name here