Hospitals and health care units are supposed to treat patients and help them while in dire need. They are paid an agreed amount for their services provided for the survival of the patients. A few years ago these payments were made in hard currency notes, but now, as most American citizens have insurance plans, the payments are made as reimbursements to the health care units once the claims are approved by the insurance companies.
These claims require medical and financial knowledge to be made. And medical coders, who are masters in both the fields, format the medical insurance claims for recovering the payments.
The healthcare units either have a team of medical billers and coders, working side by side to run the hospital smoothly, or medical billing services, to whom they outsource the unit’s payment and claims.
The affordable care act has made it mandatory for people to have health insurance. ObamaCare, a plan for the said service, has become part of the American government. And this means every person in the US is entitled to basic health care services free of charge.
Choosing a medical health care service
A health care unit or a hospital needs to analyze first if getting a medical healthcare service is the right choice. The estimates should be made after finalizing the budget. Apart from the budget and costs, the trained staff needs to be monitored for the first three months to see if they are doing a satisfactory work.
Of course, unlike an employee, you can always cancel the contract with the medical healthcare service for billing claims, but that is not always a wise choice.
See if claim rejection decreases
As a healthcare service, your first task should be to check the ratio of claim rejections. If they have decreased after hiring the medical healthcare service, then it is better to go with in the long term as well. But if the rejections increase then replace the service as soon as possible.
Claim rejections can occur due to many factors. The most important factor is the errors by the human beings. The claim rejection can occur due to mistyped codes in the claim period, or may be the billing coder didn’t do a satisfactory task.
How much percentage they charge and what’s the turnover rate
Third and final thing to check while hiring a medical billing service is what is the percentage they charge. Check if they work on percentage model or the fixed payment model. Usually, the billing services work on both the models and it is up to the health care unit to decide that which service they would like to buy.
The end result for a healthcare service is to get profit from their claims and to get them accepted early. If the medical billing service can help with both the tasks, then there is no reason that the healthcare unit will not hire the medical billing service for bill processing.
A high turnover rate can be a plus factor for hiring a medical billing service. The best way to gauge this is to keep the medical billing service first on a trial period if it performs well during the trial period than hiring its services. But if the medical billing service doesn’t show satisfactory results then it should be let go.
Before buying a medical billing service, atest that the medical biller and its mind. Secondly, check if the claim rejections have receded, and do the billing services provide better turnover or not.