I-Med Claims - Medical Billing Company
Evaluate medical billing service provider

How To Evaluate The Medical Billing Service Provider?

Patient care is one of the healthcare professionals’ key goals. From the Hippocratic Oath until the present day, the dictum “First, do no harm” has served as the cornerstone of all medical ethics. From hospitals to equipment makers to pharmaceutical testing labs, every action, product, or decision must be made with the patient’s care in mind. Physicians must hire a medical billing company that can considerably decrease the hassles associated with billing concerns. Although each healthcare provider has different needs, criteria may vary based on the size and extent of your activities. 

How Do You Evaluate Medical Billing Services?

Here are some important points to consider when choosing medical billing service provider.

  • It should be well-established with demonstrable experience in the industry. A medical billing company must have prior experience that can charge both Medicaid and Medicare.
  • The service should have American Medical Billing Association-certified people on its team. That implies they are well-versed in medical technology, ICD-10, CPT, and HCPCS coding.
  • It must protect patient privacy by complying with the Health Insurance Accountability and Portability Act (HIPAA).
  • It should maintain a high standard of service quality. Make it clear in the service agreement if the provider will follow up on refused claims and unpaid bills.
  • It should also provide several support channels, including email, phone, and live o features, and improve the practice’s revenue cycle.
  • It must have the ability to take advantage of cutting-edge technologies and have a viable pricing approach.
  • They must be able to meet the expectations of your billing cycle on schedule.
  • The service must share information on how to enhance the practice. It should also include reporting and analysis tools that can be extremely beneficial to the medical professional.

What Features Do You Require In Medical Billing Service Provider?

You will require the following services from an expert medical billing service provider:

  • Claim submission 
  • Insurance claims verification and processing 
  • Adjudication, posting, and processing of payments
  • Patient billing
  • Days in A/R 

These are the essential components of a successful medical billing services firm. To pursue denied claims, the provider should be extremely efficient. Following up with insurance companies should be one of their primary abilities.

Medical cost concept with calculator and stethoscope

How To Evaluate The Performance Of Outsourced Services?

When a provider decides to outsource their services, the following step evaluates their performance. There are a few points to consider before outsourcing:

Claim Submission: The insurance company may refuse some claims due to late submission and a lack of follow-up. You should examine if your medical billing service provider is submitting claims to the payer on schedule and how active they are in following up on claims. 

Accounts Receivable: Days in AR (Accounts Receivable) are another important criterion to consider when considering medical billing service provider. If your AR days are fewer than 30, your medical practice is doing extremely well. On the other hand, if the ratio exceeds 60 days, you may need to review how your medical biller handles claims and requests corrective action.

Denial Management: Denial management is at the core of every medical billing service provider’s effectiveness. If your medical billing service provider implements a comprehensive, constantly developed operational method, you could expect to continuously get 80% of your predicted collections. The performance difference is around 20% higher. A thorough denial management procedure is essential for ensuring timely and complete payback.

HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) concerns data privacy. You make sure that the company you hire for medical billing services is HIPAA compliant. This law was passed to check sensitive patient information from falling into the wrong hands.

Industry Knowledge: When evaluating the experience of a medical billing service, providers must go beyond the number of years the organization has been in business. Experience comprises both time and experience with certain specialties. Billing certification is also important in this case. Because billing methods differ by medical specialization, a provider should select a billing agency that is conversant with their expertise. Experience billing to Medicare and Medicaid will be extremely beneficial in any specialty.

Use Of Technology: A corporation equipped with sophisticated billing software does not guarantee that it will do an effective job. To take advantage of everything the billing firm software offers, they must have the necessary procedures in place. Most crucially, a provider will want to know about a company’s information sharing, data security, recovery methods, and data backup protocols when it comes to technology.

Capability to Handle Emergencies: Medical billing is a critical and complex process. Indeed, even little errors can result in significant financial and reputational losses. A firm that has a plan to maintain business continuity in the event of an urgent and unforeseen calamity should be considered for recruitment. Using a reputed organization may help improve the essence of patient concern while also increasing cash flow.


The medical billing service provider handles the important tasks in the billing process, saving up a significant amount of time for the physician that may be better spent seeing more patients in a day. Practical implementation of the factors mentioned above will enable your medical practitioners to make the correct decision. No one wants to lose the single pie for which they have assisted the patient. A medical billing service provider can be an essential partner and service provider in your medical institution.

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