choosing a medical billing service

What to Look for When Choosing a Medical Billing Service

Are you looking for a medical billing service to manage your patient accounts? If so, then you're going to want to learn the pros and cons of the solution, what to look for when choosing a medical billing service, and how these companies work to get your money from patients who owe.

It's projected that the medical billing outsourcing market will reach a value of $16.9 billion by 2024 from $6.3 billion in 2015.

The same report showed that an estimated 95 percent of medical practitioners believe that outsourcing medical billing revenue system is one of the best innovations in the medical sector.

The above figures can only mean one thing. That medical billing services have come to stay.

Nonetheless, if you looking to get a good medical billing service to manage your patients' accounts there are things you must know.

Choosing a medical billing service will require for you to learn about the pros and cons of the service, what to look out for when getting the best service and so on.

So, if you are interested in knowing about this, keep reading.

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Factors to Consider When Choosing a Medical Billing Service

There are a lot of things to consider when choosing the best medical billing service. These are the most important.

The Qualification and Credentials

QualificationsWhen choosing a good billing company, it is important to ensure they have good procedures and policies. These procedures should be able to reduce the time for payments to sail through. It should also increase the efficiencies of practice workflow.

You should also ensure that the billing company complies with HIPAA Omnibus Rule. The company should have a thorough compliance program. This ensures confidentiality, privacy, and security of protected health information as well.

There are important questions you should ask. For instance, if the company does self-audit, how often do they do self-audit? Do they test the knowledge of their employees often?

It is also important you inquire about the number of staffs that have a certification in the certified professional biller program. You should also know how the billing company supports continuing education for their staff.

Their Ability to Help Measure the Health of Your Practice

As time goes on, you will have to rely on your billing company to give you expert counsel for making the right workflow decisions. This is to help your establishment meet her future needs whilst checking the health of your organization.

Hence, it is necessary to choose a medical billing company with experience in IT resources. They should also be able to evaluate reimbursement data analytics, staffing levels, and accessing existing administrative policies. The reason for this is to help you focus on providing quality patient care.

Medical TechnologyThe Technological Capability of the Company

Medical billing companies do more than reimbursements. Hence, a good billing company should have vast knowledge and expertise to advise you on the best technology you need per time. This will help you meet regulatory requirements and needs.

The billing company should have experience in EHRs, practice management, and billing systems. With this, the billing company can integrate systems properly.

If your goal is to upgrade an existing IT solution or you are looking for a new implementation, the right billing company should meet those technological needs.

Staffing and Workload

When you are looking for a good medical billing company, ensure that using their services helps you reduce the workload on in-house staff. Your in-house staff can schedule patients, manage patient co-pays and payments.

They can also control demographics, whereas the outsourcing company takes charge of the back-end operations.

It's necessary to decide if you want the contracted billing staff to work on-site or off-site. It's in your place to know what the most cost-effective option for your facility is.


Some medical billing companies specialize in outpatient surgery, diagnostic services, physician practices, and more. That is why it's important that your billing company understands the nuances of your business.

This will enable them to provide lower denial rates and good reimbursement rates.

Outsourcing to a billing company is a relationship beyond the contract. Hence, the billing company you choose should be a partner that ensures your business is successful. The company should also make you feel confident and comfortable about your choice.

Medical Claim DenialMechanism for Denials

Before you make your decision about a billing company, ask about their track records with denials. You can also ask the company “what are the mechanisms they use to prevent denials?”

You also have to be clear about their follow up system when an operative note is not clear. A good medical billing company should take responsibility for the work involved in winning appeals when the need arises.

Detailed Data

No doubt, the healthcare sector has so much data. The role of a good billing company, in this case, is supplying data fast. If there is a delay in changing your documentation, you stand a chance of losing so many potential reimbursements.

Hence, it is crucial to ensure the billing company has a solid process of delivering the information you need.

ProsThe Pros of Choosing a Medical Billing Service

What good do you gain by choosing a good medical billing service? Continue reading to find out.

Outsourcing Reduces Billing Errors

When you outsource your patient billing to professional and experienced medical billers you can rest assured that your claims will be submitted in a prompt manner.

It is the role of the medical billing service company to ensure their hired billers undergo a comprehensive training. These billers must be informed with the knowledge to submit medical claims in an accurate way.

By this, it will lessen the number of rejected and denied claims due to billing errors. It will also aid in generating a good feedback system that will help maximize reimbursements on future claims.

Outsourcing Saves You Money


Outsourcing your medical billing could save you thousands of dollars in benefits and annual salaries. It will even save office furniture, office supplies, upgrading, purchasing and maintaining billing software alongside the computer equipment.

Most medical billing companies charge a flat rate per claim. They can also charge by percentage of the reimbursement on each claim.

No matter the option you choose, it less expensive than what you would have paid a medical billing staff to deliver the exact exceptional services.

Outsourcing Enables You to Have More Focus on Your Patients

By outsourcing your billing functions, you will be able to spend more time focusing on your patients. By this, your level of concentration for your patients' satisfaction will improve. You will also be able to give quality care to them.

This is more advantageous to smaller medical groups that can't afford a big medical office staff. It will also reduce the stress level of your staff.

Your level of productivity will dwindle down when you try to pay attention to both your patients and the financial side of your practice.

ComplianceOutsourcing Ensures Billing Compliance

The medical sector is an ever-evolving industry, and the insurance companies have a partial role to play in all these. These constant changes in the Medicare, third-party payers and Medicaid have been seen as a challenge to the healthcare sector.

Thus, it's a big deal to ensure that the medical office is adhering to the right protocol required by every payer. That is why the medical billing service companies stay up to date.

Outsourcing Improves Your Cash Flow

In a case where your in-house medical biller goes for a vacation, what will you do? Will the claims have to wait till they come back from their vacation before it's submitted? These billing interruptions will affect your cash flow and promptness of reimbursements.

With the use of a medical billing service, you will not have to worry about such.


Because the medical billing service ensures there is a steady, consistent flow of cash coming in and claims going out. A steady cash flow is crucial to run your medical establishment.

Outsourcing Gives You a Competitive Advantage

This is another great advantage you derive from using a medical billing service. Nowadays, patients have become more knowledgeable about health care services. In fact, they now make choices based on the services the medical provider can offer them.

Thus, the competition in the medical industry has grown to a large extent. To stay and grow in the industry, you will have to maintain a solid competitive advantage amongst your competitors.

Therefore, not having a medical billing service will be bad for the competition, when other competitors utilize their services.

ConsThe Cons

On the flip side, these are the problems you can encounter with a medical billing service.

Possible Hidden Costs

When moving your in-house billing to an outsourcing company, they could be some hidden costs incurred. In particular, there may be so much time spent and more costs incurred when preparing the work arrangement between the outsourcing company and the medical office.

Also, it's possible that you hire at least a new liaison staff that will have to mediate between your medical office and the outsourcing firm. So, it's important to make provision for such hidden costs when choosing a medical billing service.

The costs vary depending on the service provider.

It's best to get a quote before your pick the outsourcing firm to work with.

HIPPA Privacy and Security Breaches

Sometimes, a possible problem may arise with HIPPA privacy and security when you outsource your medical billing. Even though violations of HIPPA privacy and security can still rise with in-house billing, it presents a greater risk when it's outsourced.


There is a greater risk of a breach when more people have access to confidential and private information of patients or the establishment.

An accidental disclosure of PHI is seen as a violation of HIPPA.

Contracts With Medical Billing CompaniesContractual Misunderstandings

There are cases where everything seems to go well at the beginning. Then things start going bad, causing a decline in the resulting outcome. This happens when both the medical office and the outsourcing firm interpret the contract from a different view.

This scenario is seen most times in many agreements. This contractual misunderstanding can arise between both parties because of the legal lingo. Thus, it's crucial that you make room for any adjustments in the contract agreement.

Possible Limitations of the Outsourcing Company

Some limitations may arise within some outsourcing firms. Lack of access to information and communication between the medical establishment and the outsourcing firm is one. This may limit the services provided by the outsourcing company.

Therefore, an operative communication system should be developed during the initial contract phase. There should be an agreement that will allow the outsourcing company access to proper data they require. By this, they can produce a successful billing system for the medical claims.

How the Medical Billing Service Get Your Money from Patients That Owe You

Here are the steps medical billings companies take to get your money from patients that owe you.

Patient Check-In

If a patient calls to book an appointment, a receptionist schedules a time slot. If it is the first visit of the patient, the front office collects the details of the patient.

Some of the basic details include name, date of birth, address. It also includes a reason for visit, patient's policy number, and insurance information. All these details are used to create a file for the patient.

This process helps cut registration hiccups or potential errors.

Confirming Financial Responsibility

After the initial process, the office of the physician bills the patient. After which, they address the bills to the person responsible for the medical services. All these happen before the patient's appointment

The first step to take is to get familiar with insurance coverage of the patient. After this, the office confirms the services covered under the recent insurance policy of the patient, and what medical diagnoses the insurance provider needs to defend payments for the services.

When all requirements are met, the process of billing is explained to the patient.

Patient Checking inPatient Check-Out

In a patient's medical record, the physician's services are recorded. This helps create an accurate medical bill for the patient or insurance provider.

The medical coders assist in translating medical procedures performed at patient's visit. All the diagnoses are translated into a series of medical codes. This serves as a universal language in the healthcare industry. After this, the medical bill gets processed.

It is the duty of the medical biller to calculate the patient's balance in the patient ledger. This is issued as a receipt to the patient before they can check out.

Coding and Billing Compliance

Since different medical facilities have different billings, the medical bills carried out by the biller have to be done with accuracy. This is necessary to ensure that the charges match the specific medical practice standard set.

Transmitting the Claim

Once the medical procedures, diagnoses are coded, they will go for recording and checking to meet the compliance rules. Then the bill is sent out to the payer or insurance company.

Receiving Payments from Insurance Companies

When the insurance company receives the bill, a process called adjudication is done. This helps the insurance provider to review a claim from the healthcare provider and check the bill.

Billing Patients

For payments to enter a patient's account, the following must take place.

The codes listed in the insurance provider's transaction report and procedures should align with those sent by the healthcare provider. The charges should be compliant with the financial agreement of both parties, and the healthcare provider must get the right reimbursement.

Collecting Payment

The payment is closed when a patient receives a bill with the remaining balance for the medical services provided. Also, the healthcare provider is reimbursed completely after the patient receives payment.

Wrapping Up

By now, it's clear enough that outsourcing your patient billing to a medical billing service is the best decision you can make.

It's obvious that there are merits of demerits of choosing a medical billing service to handle your patient billing. Thus, be sure to weigh all your options before making any decision.

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Author: Hudson Piccini

Hudson Cynar, a Harvard University alumna and the owner of three prosperous enterprises, is a distinguished business consultant, author, and writer. Her expertise spans multiple business sectors, with a particular emphasis on storage containers, commercial copiers, payroll services, and medical billing software. Dedicatedly investing thousands of hours into product and service research, Hudson crafts insightful reviews to guide entrepreneurs in making informed decisions for their businesses.