4 Factors to Check Before Hiring A Health System Billing Company

Providing treatment to patients is a hectic task for most providers. This is mainly because of different procedures, equipment, and medications that are required for patient care. On top of that, getting proper reimbursement for providing complex medical services is quite a challenge. Most health clinics have in-house billing teams that take care of reimbursement and insurance claims. However, there are a few reasons that make hiring a professional health system billing company more beneficial. To achieve optimum results and ensure the safety of patient data, practitioners must consider certain factors before hiring an external company. This will not only improve reimbursement rates but also protect their practice from compliance issues.

Things to remember before outsourcing health system billing

Healthcare clinics treat patients suffering from various diseases that require specialized procedures and equipment. In the same way, the reimbursement policies also change, depending on the insurance companies. Before hiring an outsourced health system billing company, a few factors must be considered.

1. Range of billing services

It is important for healthcare clinics to verify whether the company offers comprehensive services that cover all stages of the medical billing process. This includes all the important tasks from patient registration to final payment collection. The range of billing services refers to the variety and extent of medical billing and revenue cycle management services that a health system billing company can provide.

Checking the range of billing services helps a healthcare organization determine whether the billing company can meet its complete financial and administrative needs. Professional health system billing services can offer the following advantages:

• Convenience – The healthcare organization can obtain multiple billing services from one provider.

• Improved efficiency - Coordinated billing activities reduce administrative delays and duplication of work.

• Fewer billing errors – Outsourced companies have trained staff and certified coders who reduce errors and rate of claim denials.

• Better financial visibility – Regular reporting helps management monitor revenue and identify areas for improvement.

Let us assume that a hospital hires a health system billing company that does not provide dedicated denial management or accounts receivable follow-up services. In this case, the hospital may have to employ additional staff or hire another company. Whereas hiring a billing company that offers comprehensive services can manage all the necessary reimbursement activities.

2. Claim accuracy and denial management

A medical billing company must be able to prepare and submit accurate medical claims. These companies should also handle claims that are rejected or denied by insurance companies after submission. Besides submitting accurate claims for reimbursement, billing companies must also be able to manage denied claims and follow up on aging accounts receivable (AR).

When providers check claim submission accuracy of a billing company, it means ensuring that all information included in the claims is correct and in compliance with regulations. This also leads to verification of the following aspects:

• Verifying patient information – Confirming patient names, identification details, and insurance information.

• Checking insurance coverage – Confirming that the patient's insurance policy covers the services provided.

• Reviewing billing details – This helps in verifying charges, provider details, and other claim information are entered correctly.

• Ensuring coding accuracy – Using the correct and updated codes when preparing claims.

Denial management refers to the process of identifying, analyzing, correcting, and following up on medical claims that insurance companies refuse to pay. An experienced billing company must be able to identify denied claims, correct billing errors, and resubmit claims.

With accurate claim submission and proper denial management, providers can get the benefit of reduced claim denials, improved revenue collection, and faster reimbursement.

Suppose a hospital submits 1,000 insurance claims through a billing company.

• 900 claims are processed correctly.

• 100 claims are denied due to coding errors, missing documentation, or authorization problems

The reason for denials must be identified, and errors must be corrected by the health system billing company. The professionals should also introduce measures to prevent similar errors in future submissions.

3. HIPAA compliance and data security standards

It is the responsibility of healthcare clinics to ensure that sensitive patient information is protected from possible cybercrimes. Before hiring professional health system billing companies, the objective is to confirm whether the company prioritizes the security of patient data.

The Health Insurance Portability and Accountability Act (HIPAA) is a US federal law. It establishes standards to protect sensitive health information of patients. This means a billing company must secure patients’ protected health information (PHI), prevent unauthorized access, and follow HIPAA rules. It is advised to check the following security parameters before partnering with an external company:

• Data encryption - Patient data should be encrypted both when stored and when transmitted.

• Access control - Only authorized employees should access patient information.

• Employee training - Staff should receive regular HIPAA and data security training.

• Secure systems - Billing software and databases should have appropriate security protections.

Providers must remember that HIPAA does not issue any official certification that makes a company HIPAA compliant.

4. Application of updated software and AI

With the advancement in technology and the invention of artificial intelligence (AI), the healthcare billing industry has also evolved rapidly. Providers must verify whether a health system billing company implements advanced technology or AI for operations.

A reliable billing company must be able to demonstrate how it uses AI in actual billing operations. Some common examples of AI applications in medical billing include the following:

• Automated claim scrubbing - AI helps in the identification of missing information and incorrect codes, and before claims are submitted to insurers.

• Denial prediction - AI analyzes historical claims data to identify claims that are likely to be rejected.

• Automated payment posting - Software helps match insurance payments with outstanding patient accounts.

• Accounts receivable monitoring - AI identifies unpaid claims that require follow-up and correction.

Providers must not rely on the fact that a company uses AI for billing operations. It is crucial to ensure that its technology produces valuable outcomes in billing accuracy and reimbursement rates.

Choosing the right outsourced partner for better results

There are many companies that offer HIPAA-compliant services and also the expertise of certified coders. Providers must select a health system billing company that offers RCM solutions that are specific to their requirements. Moreover, verifying the important factors before outsourcing not only helps prevent errors but gives clinics the opportunity to improve patient satisfaction.