business of pediatrics

How to Select a Medical Billing Service

There are all sorts of reasons to hire outside of your private practice for pediatric billing. Whether you want a service to accommodate your growing practice or you’d simply like to hand over pediatric billing to a team of professionals, a dependable billing service takes a weight off pediatricians’ and office managers’ shoulders and frees time for patients and other tasks. In this post, we’ll cover how to select the billing service that’s the best fit for your practice and patients, what qualities to look for in such a partner, and the role out-of-house billing plays in your practice’s revenue cycle management.

When to Hire a Medical Billing Company

Clean claims are more readily accepted by insurance companies who pay practices the revenue they need to keep treating kids. Whether an in-house or outsourced billing service is right for your practice depends on a few factors, including costs, convenience, and the level of support needed to maintain a firm grasp on constantly shifting billing models.

According to Medical Economics, a practice should consider outsourcing if they are:

  • Experiencing frequent issues with credentialing or rejected claims
  • Using an outdated billing software system
  • Unable to keep up with constant changes in reimbursement models
  • Experiencing less cash flow than anticipated

Billing, coding, and revenue cycle management are complex, and rules and requirements for accepted claims are constantly changing -- this, on top of consistent changes to healthcare policy, means that billing is serious business! When billing issues arise, they may or may not be related to the skill of an in-house biller, but could also mean that your practice has simply grown large enough to need specialized, professional tools and support from a billing team.

How to Select a Billing Service

When shopping for a medical billing company for a pediatric practice, there are several factors to consider. Straightforward concerns like costs and reliable support are important, but would you also like your billing team to contact patients, or assist with credentialing? Outsourcing services sometimes offer these benefits for an extra fee, or they may not offer them at all. Checking that your chosen company can provide all of the services you need upfront can save hassle, time, and money in the long run.

PCC’s team of experts, including coding expert Jan Blanchard, CPC, CPEDC, CPMA, have gathered a billing service shopping list to help pediatric providers determine the billing service that will work best for their circumstances. Here are some highlights for your billing service shopping trip.

Costs

When searching for a billing company, explore both the upfront costs, such as start up fees, rates, and contract terms. Practices should also be on the watch for companies that offer packages or tiered plans so that they can better understand which services are paid contractually and which are “extra”. As mentioned above, a company may classify services such as patient outreach or credentialing as additional to their mainstay of coding and billing, or they may accept certain services. 

Another possibility is that some of the services you desire, like credentialing, may be classified in a higher tier or more costly plan. If the more expensive plan only offers one or two more benefits than the cheaper one, it may be worth considering a different company or strategy.

Services

Medical coding and billing is one thing, but does the company have experience working in pediatrics? As pediatricians well know, pediatrics is much different than general or even family medicine, and your chosen team should be prepared for the nuances of pediatric billing, such as understanding the importance of billing for infants rather than mothers during a lactation visit. Billing these visits appropriately puts the practice in a better position for accepted claims and appropriate payments.

Other services a billing company may offer include IT support, credentialing, payor contract negotiations, and consulting.

Analytics & Support

If costs and services are the meat and potatoes of a great billing service, excellent support and analytics are the vegetables and fruit that make a balanced meal. These services help a practice learn and improve their billing, which can grow their revenue and cut down claim rejection rates.

Ask potential vendors about their support request turnaround times, and what they can offer in emergency situations. Remember: moving from in-house billing to a third party means that the proximity to your biller will be a little different. Accounting for support request times and responsiveness can help set the correct expectations for your practice and your vendor.

Consider questions like: What time zone are they located in, and will your practice be able to grow a relationship with their support team? Along with great support, analytics can help a practice grow and improve their billing over time as it can point to trends, errors, and opportunities for growth.

Other Considerations

A reliable billing service should be compliant with all federal and state regulations, including HIPAA regulations. You may wish to consider a HIPAA Business Associate Agreement with your vendor.

A billing company with true integrity beyond legal compliance will be more than willing to share testimonials from their current clients -- and it never hurts to get the perspective of another pediatrician using the service. 

Your choice to move to a billing service is an important change for your practice and your business. Practice management requires a host of skills physicians may not be familiar with, like billing, coding, vendor management, and even marketing. PCC is here to help. Check out our practice management resources on PCC.com, or check below for our webinar: Revenue Cycle Tips and Tricks for the Independent Pediatrician.

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Allie Squires

Allie Squires is PCC's Marketing Content Writer and a transplant from upstate New York. She holds a master's in Professional Writing from NYU.