What to Look For in a Medical Billing Service


A survey done in 2017 by Kaufman Hall found that 25% of hospitals and health systems in America are trying to reduce their costs by at least 1% to 5% in the next five years. That same survey found that actually, most hospitals will have to cut their costs by close to 30% in the next five years if they actually want to stay competitive. One of the biggest reasons for the high costs when it comes to providing healthcare is the enormous amount of paperwork involved in healthcare claims and processing services.

Medical claims, especially those going to government entities, are complicated and time-consuming. To decrease the burden in time and manpower required to process all of these claims, and to increase collection rates, more and more hospitals are choosing to outsource their healthcare claims and processing services. Choosing a healthcare claims and processing service is not a simple task, but choosing the right one can save a lot of money in the long run. Here are some things to look at in choosing a billing and claims service:

Investigate The Quality of Their Specialists

It’s not enough to simply look at the company itself. You need to also ask about the credentials and experience of the individuals who will be working with your healthcare service. Find out exactly who you’ll be working with and who will be processing claims. What kind of training are they offered? What kind of professional development do they go through in order to keep up with the many changes in paperwork demands?

Look at the Average Collection Rate

One of the biggest reasons for outsourcing healthcare claims and processing services is the need to increase collection rates. This means that one of the most important things to look at when considering any service is their average collection rate. Their collection rate needs to be higher than what you’re currently getting or it might not really be worth the investment.

Look at the Company’s Experience

In addition to looking at the individuals you’ll be working with, it’s important to consider how many years the different healthcare claims and processing services you’re considering have been in operation. The longer they’ve been working, the more likely they are providing good results. This also means they should have other satisfied clients they can refer you to. Be sure to check with those referrals.

Ask About Average Processing Rates

The last thing you want is slow cash flow because claims are not getting processed quickly enough. There are always times when things go faster and times when things go slower, but it is important to check out the average rate and make sure it’s at least as fast, and preferably faster, to the rate at which you already process claims.

Ask About Support

Things don’t always go as planned. This is just a fact of life. Any good company needs to have a contingency plan for when they don’t and a way for you to get support and follow-up as necessary. Be sure to find out what support looks like for the healthcare claims and processing services that you are considering. How easy will it be to contact them? Will there be someone dedicated to working with you, or will you get a different person every time you pick up the phone and have to re-explain the issue over and over? Are there hours or days when you won’t be able to get any help at all?

What Kind of Medical Claims Management Software Are They Using?

It’s important to find out whether or not the service you are looking at is using the most up-to-date software available. Ideally, their software will not only be up-to-date, but also flexible to allow for future changes in billing practices, government regulations, or insurance issues.

These are just a few things to look for as you consider healthcare claims and processing services. Finding the right service can mean better cash flow and reduced paperwork for you. Getting the wrong service can exacerbate an already difficult problem. Make sure you are carefully vetting whatever medical claims billing service you are thinking about using.