Medical billing companies rely on a wide variety of comprehensive, innovative tools and carefully detailed processes to maximize accuracy and efficiency. Ultimately, all the medical billing & coding work that they perform leads to positive outcomes of obtaining reimbursement from either insurance companies, the patients themselves or in some cases, both parties. Learning a little about industry best practices and how billing and coding services companies follow them should help you understand how a medical billing firm can improve cost-effectiveness and efficiency for your healthcare organization, supporting your efforts to provide top-quality care to your patients.


Medical Billing and the Revenue Cycle

Medical billing companies receive reimbursements on behalf of their clients. These payments for medical services can come in several different forms:

  • Cash payments
  • Deductible amounts
  • Copays
  • Insurance company reimbursements

Medical billing firms support their clients’ revenue cycle management. According to OHSU, the Healthcare Financial Management Association explains that the revenue cycle refers to “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” With any multi-step cycle, there are always possibilities for the introduction of errors. If problems earlier in the cycle are not detected and resolved, the end results can be disruptive, time-consuming and costly.


Straightforward Patient Financial Policies

Experienced medical billing companies bolster revenue cycle management efforts by establishing explicit, coherent patient financial policies. These usually include some sort of agreement between the patient and the service provider, delineating out the expectation that the client will pay for any expenses not reimbursed by their insurance. As shown by a resource document from the American Academy of Family Physicians, it should also specify any additional rules regarding payment and billing. Finally, keep in mind that these policies need to be followed carefully before sending a patient to collections for non-payment.


Communication Between Provider and Biller

Clear communication between providers and patients is one thing, but it’s also a must between a billing firm and the providers that hire it to manage their billing and coding tasks. Medical billing companies maintain open lines of communication, clearly spelling out the services they offer as well as what they expect from the clients that contract them.


Clearly Define and Disclose Fees

Both patients and billing services providers need to understand a healthcare organization’s fees. Setting down a clearly-worded explanation not only benefits patients, as they will be aware of what their care costs them and who is ultimately responsible for remitting payment, but such documentation also aids the billing company. It is the job of providers to accurately and comprehensively disclose this information to patients, so that “surprise fees” are eliminated and medical billing companies do not encounter hassles and difficulties collecting for services.


Use Solid Methodologies and Documentation

In short, medical billing & coding firms must have a solid plan for collecting insurance, copays, deductibles and other kinds of payments for services rendered to patients. Since critical errors are possible at every stage of the revenue management cycle, it’s vital that meticulous, reliable methods are transparent policies are in place for every process. Moreover, clear communication should exist not only between healthcare providers and patients, but between care providers and the medical billing companies they hire.

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