How to Choose the Right Medical Billing Services Company for Your Practice

How are your claim denials and first-pass acceptance rates? If you’re being challenged, you’re not alone.


Hospital claim denial rates are on the rise. Reports reveal that they have increased by 20% over a 5-year period, with more than 1/3rd of hospitals facing an average denial rate higher than 10%. 


The major reason behind this is the increased pressure on resources. A study published in the Journal for Healthcare Quality shows that an increase in workload leads to greater instances of medical billing errors, and thus, greater denials.


Thus, when you handle this billing process in-house, it becomes quite difficult to meet the industry standards of keeping your first pass acceptance rates above 90%, your days in A/R below 60, and your denials within 5%. 


This is why engaging a professional medical billing service provider becomes crucial for increasing billing accuracy, processing claims faster, and optimizing your overall cash flows and revenue cycle.


However, you need to be sure you onboard the right billing partner that fits your needs. To streamline this search for you, we’ve compiled a list of the top factors and qualities to look for in your medical billing service partner.


7 Factors to Consider When Choosing a Medical Billing Services Company



1. Industry Experience & Expertise

You need a medical billing service partner with years of experience in the industry. Look for a billing company that has a strong market reputation, proven expertise in revenue cycle management, and some good success stories to show.


Even better if they specialize or have experience in your area of practice, be it urgent care, ambulatory, or others. It helps to check their expertise and success stories in enhancing cash flows, improving acceptance rates, or reducing denials for other medical practices. 


Additionally, it’s important to check their knowledge and familiarity with various practice management software, insurance companies, and partners you work with. A company with a vast breadth of experience with different companies and leading software can be extremely beneficial in handling the requirements of your billing system without disruptions. 


2. Compliance & Security 

Compliance with HIPAA regulations is non-negotiable in healthcare. Ensure that the medical billing services company you reach out to demonstrates a strong commitment to adhering to such requirements and regulations. 


Enquire about their compliance measures and security protocols for safeguarding patient data and maintaining confidentiality. Do they keep up with the changing compliance regulations? Are they up-to-date with the latest coding requirements? Do they regularly train their staff on the same? A yes to these questions will help you avoid compliance issues in the future.


As an extra measure, you can even verify their certifications and accreditation to ensure they meet industry standards for quality and security. A reputable billing service should have robust data protection policies and a proactive approach to mitigating cybersecurity risks.


3. Past Track Records

A quick look at past track records is a great indicator to judge whether a medical billing service partner is right for you or not. 

Look for information on quality metrics that matter to you; and compare it with their historical records and performance. What do their acceptance and denial rates look like? What are their average days in accounts receivable? A first-pass acceptance rate of >90%, and a claim denial rate of <5% indicate their efficiency and accuracy in billing processes.


Besides these quality metrics, a look into their turnaround times for claim submission, payment posting, and resolution of outstanding accounts will give you a great understanding of what to expect. A company that can expedite these processes is more likely to enhance your revenue cycle management and improve your cash flow.


4. Insights and Reporting

A great medical billing service company doesn’t just help you with your billing, it helps you optimize your revenue cycle throughout. Look for companies that share regular insights and comprehensive reports into your performance, aiding your decision-making.


The right company will even go beyond basic reporting and provide weekly or monthly reports, customized to align with your practice’s specific preferences and goals. These detailed insights into your revenue cycle performance covering key metrics help you identify areas of concern and make adjustments accordingly.


In fact, it helps to look for a proactive billing partner that is willing to detect potential issues or downward trends and alert you about them. Besides developing transparency, this stance allows you to take corrective actions before minor hiccups escalate into major financial setbacks.


5. Operational Transparency

Staying informed and updated about your billing procedures is vital. This is why you need to find providers who are known for their operational transparency and open communication. 


Prioritize the medical billing companies that offer transparent workflows, providing you with regular updates on your revenue cycle and claim statuses. In these cases, companies equipped with real-time reporting capabilities make a great choice, since they allow you to track claim progress and financial performance effortlessly.


6. Customer Service & Support Offerings

You will need on-time and reliable support from your medical billing partner. The company you are looking for should have active customer service and support. Service providers that offer a dedicated account manager or manual support team can do wonders for your practice and ensure its smooth operations. 


Personalized support, open communication channels, and proactive engagement are great indicators all pointing towards a trustworthy medical billing company. A great way to get a sense of their customer service is to enquire about their expected turnaround times for queries and resolutions. Quicker responses indicate a proactive customer support line.


7. Cost-Effectiveness

Your medical billing partner should bring more benefits than costs. That is, it’s important to look for a company that offers great value for your money. Dig in with some research and gather information about different medical billing and their offerings.


Use the above metrics to compare the pricing structures of the different billing service providers in your list, while assessing the value-added services they offer. Providers that go beyond basic billing functions, offering analytics, reporting, and revenue optimization services deliver a higher ROI and are more cost-effective.


Understanding Your Requirements

Your needs are specific and unique. Knowing what you want will not only streamline your search but also ensure you find the right service partner tailored to your practice’s needs.


Assess the specific needs of your medical practice. Factors such as size, specialty, and location can all influence the type of billing services you require. Further, you should also evaluate your current billing software and workflow to identify gaps or areas for improvement. These steps will give you a clear understanding of what you want from the medical billing service partner. 


Key Takeaway

Finding the right medical billing service partner can significantly improve your cash flows, minimize denials, and enhance your patient experience. Noting the factors above forms a great checklist for choosing a great partner for your billing procedures. 


In general, it’s also important to be mindful of extra activities and demands that may arise. Many providers charge extra fees for these additional services, increasing your overall costs. It helps to seek providers that are on top of dynamic customer needs and do not impose additional charges for accommodating your specific requirements.


At Lister, we listen to your needs and serve as a reliable ally dedicated to improving your cash flows, reducing denials, and enhancing the overall financial health of your practice. 


Our experienced professionals are always up-to-speed with the latest billing and coding practices, allowing us to handle your billings with ease, while you get to focus on delivering exceptional patient care and growing your practice.


Looking for ways to improve your claims and optimize your revenue cycle? Contact our experts for a free audit of your current billing system! Write to us today