Why Do Providers Choose a Medical Billing Partner, & How?
Hiring an expert team can make all the difference.
The Problems Providers Face with Medical Billing and Coding
In today's complex healthcare market, providers face numerous challenges that can severely impact their practice’s efficiency, financial profitability, and operational success. By partnering with an experienced medical billing company, optimizing your billing process and reimbursements is easier than you might think!
Are You Struggling With These Same Medical Billing and Coding Issues?
Most providers encounter the same problems:
🚫 Inaccurate or Incomplete Coding – Coding errors result in claim denials, lost productivity to working resubmittals, and even lost reimbursements.
🚫 Underbilling – Missing billable services or misinterpretation of clinical notes leads to unnecessary revenue loss.
🚫 Underpayments – Receiving less than what you are owed from payers directly reduces profitability.
🚫 Delayed Claim Filings – Delayed claim filings causes work to pile up, internal frustations, and cash flow disruptions.
🚫 Untimely Claim Filings – Entirely missing payer deadlines is automatic claim denials and lost revenue that could have been reimbursed.
🚫 Passive Accounts Receivable Collections – Lack of proactive follow-up on unpaid balances makes aging balances exponentially harder to collect.
🚫 Passive Pursuit of Reimbursements – Insufficient engagement with insurance companies causes delays in standard payment timelines.
🚫 Duplicate Claims – Submitting multiple claims for the same service can cause payment delays and potential audits.
🚫 Lack of Compliance with Changing Regulations – Constant updates to medical billing codes, payer policies, and federal regulations can lead to non-compliance, resulting in claim denials, fines, or audits that disrupt cash flow.
🚫 Inconsistent Charge Capture – Missing or inaccurately documenting billable services leads to lost revenue, reimbursement shortfalls, or improper revenue tracking.
🚫 Excessive Write Offs – Failing to appeal denied claims leads to unnecessary financial losses.
🚫 Employee Turnover – High billing staff turnover disrupts cash flow, causes frustration, loss of training investment, and inconsistency of workflows.
🚫 Poor Claims Tracking – Inefficient claim monitoring results in lost revenue opportunities.
🚫 Credentialing Tediousness – Complicated credentialing processes delay provider enrollment and reimbursements.
🚫 Patient Collections Problems – Difficulty collecting patient balances weakens financial stability.
🚫 Challenges with Prior Authorizations and Insurance Verifications – Time-consuming tasks delay patient care and reimbursements.
🚫 Complex Payer Mix – Navigating intricate, unique payer requirements can lead to confusion and costly mistakes.
🚫 Incorrect Patient Data – Submitting claims with incorrect patient data or modifiers means denials, payment delays, and compliance risks.
🚫 Employee Overhead Costs – Maintaining an in-house billing team significantly increases expenses with employer taxes, payroll, training, benefits, vacation, and equipment.
🚫 Insufficient Documentation for Medical Necessity – Lacking enough clinical notes to support medical necessity can lead to claim denials and increased scrutiny from payers.
The Medical Billing & Coding Experts We Refer
Best Billing Professionals
✅ Nationwide Reach – Trusted medical billing and coding experts serving providers across the U.S.
✅ Industry Experts – Extensive experience optimizing billing for healthcare practices.
✅ Proven Performance – Only top-rated billers and coders with a strong track record of maximizing revenue for myriad providers.
✅ All Specialties Covered – Experts in every medical field, from primary care to complex specialties.
✅ Tech-Savvy Users – Flexible teams that work within your EHR & PMS software platforms.
✅ Comprehensive Solutions – Beyond billing, they offer credentialing, patient scheduling, prior authorizations, and more!
Frequently Asked Questions in Medical Billing
Industry Experience – How many years do you have in the medical billing industry?
Experience varies by company. It’s important to choose a billing partner with proven experience across your specialty and a solid track record in revenue cycle management.
📍 Proactive Calling and Electronic Inquiries – Do you use both phone calls and electronic methods to follow up on claim statuses?
The most effective billing companies use a combination of phone calls and electronic inquiries to ensure claims are tracked, followed up on, and resolved quickly.
🎓 Staff Expertise – Are your billers and coders experienced in my specialty?
Specialty-specific expertise is crucial for accurate coding and maximum reimbursement. Be sure your billing partner assigns staff familiar with the unique coding, documentation, and payer rules of your field.
🔒 HIPAA Compliance – Will you sign a Business Associate Agreement (BAA)?
A reputable billing company should always be willing to sign a BAA to ensure HIPAA compliance and protect patient data.
⚖️ Appeals & Follow-Ups – Do you aggressively handle denials and go through all levels of appeals?
Effective billing teams don’t stop at the first denial. They pursue valid claims through multiple appeal levels to recover every dollar owed.
🔄 Software Expertise – Can you work within my existing PMS, clearinghouse, and EHR systems?
The right billing company should be flexible and capable of working within your current software environment to avoid disruption and save time.
📊 Accounting & Reporting – How often do you send revenue reports, and can they be customized?
Most billing partners offer weekly or monthly reporting. It’s best to choose a provider who will tailor reports to your practice’s KPIs and provide transparency.
💰 Payment Reconciliation – Will you help ensure payers honor their contracted rates?
Enforcing contracted rates is a key part of proper payment reconciliation. Look for a partner that actively monitors reimbursements for accuracy.
📖 Industry Knowledge – How do you stay up to date on billing regulations and coding changes?
Medical billing companies should have ongoing training programs and a compliance process to stay current with regulatory changes and payer updates.
💳 Collections Approach – How do you manage accounts receivable collections to maximize recovery?
Look for a billing service that uses a systematic approach to AR follow-up, with aging prioritization and strategies to recover older, unpaid claims.
📑 Credentialing Support – Do you offer credentialing support and help with payer contracts and compliance?
Many billing companies offer credentialing as an added service. This can be beneficial when onboarding new providers or keeping your enrollments up to date.
💼 Fee Structure – How do you structure your fees—by claims volume, collections, or flat rate? Are there setup fees or long-term contracts?
Fee structures vary—some charge a percentage of collections, others a flat rate. Ask about any additional costs, such as setup fees, and make sure the agreement aligns with your budget and goals.
📞 Account Management – Will I have a dedicated account manager or main point of contact?
A dedicated account manager can make communication easier and ensure consistent service. It's ideal to work with someone who knows your account and can respond quickly to questions or concerns.
👥 Backup Coverage – What are your hours of operation, and do you provide backup coverage?
Check to see if the billing company has extended or after-hours support and whether backup staff are available to maintain continuity during absences or busy periods.
⏳ Onboarding and Start Date – How soon can you start, and what are the next steps?
Start times vary depending on setup and access. Most billing partners can begin within a few days to a few weeks after contracts are signed and onboarding is complete.
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