Medical billing and coding companies can be the perfect outsourcing partner to healthcare organizations to manage their revenue cycle operations. The outsourcing market in this domain has been rising for the last few years. The Healthcare Business Process Outsourcing Market report for 2022-2025 forecasts that the market size is predicted to grow by USD 7.43 billion during this time frame. The growing needs of the healthcare organizations and the steep staff shortages during the pandemic have provided the much-needed dependence on these professional RCM companies.

However, with the myriad options available in the market, choosing the right partner for you can be pretty challenging. To conclude, you need to consider various advantages and disadvantages and couple the specific needs with the financial budget. On the other hand, you also need to check for the credibility of the RCM company since they will be handling sensitive data for your organization. This article will take you through 10 easy steps that you need to follow to evaluate and ultimately choose the proper medical billing and coding companies.

1.Evaluate your Account Size:

While there are various medical billing and coding companies in the market, few are adept enough to handle all accounts sizes. Evaluate your accounts and your practice size internally to know the scale of the revenue cycle management company you need. Consider parameters like estimated budget, number of physicians, and accepted insurance companies to arrive at a conclusion. Following this step will ensure if you need small-scale billing services, target specific steps of billing or hire an end-to-end revenue cycle management service.

2.Reviewing Past Experience:

An experienced revenue cycle management company has managed the different changes in the healthcare billing ecosystem for a long time. A company with strong credentials and proven experience in handling accounts for other healthcare systems can be a great partner. Check for how long they have been in the industry. Make sure you ask them about their customer testimonials. Focus more on reviews from actual healthcare providers rather than generic ones to better understand their customer success stories.

3.Specialty Experience:

Each medical specialty comes with its own set of challenges in the medical billing process. The medical billing and coding companies on your list should have demonstrated the ability to perform well for the specialties you are looking for in your organization. If you have a multi-specialty practice in your organization, ask the company if they are current with the latest best practices. Even if you are a general practice at the moment, you may want to venture out into the specialty space. Your outsourcing partner should be able to scale up too.

4.Staff Size:

The staff in the billing accounts are ultimately the ones who will do the groundwork for you. The medical billing company should have enough teams to handle the size of your accounts. Without enough trained professionals to support you, you might feel overwhelmed with the incredible number of bills in an otherwise non-peak time. Discuss how many people will be assigned to your account and support you in time of emergency.

5.Cost Estimates:

Budget is one of the crucial factors to note before zeroing on one particular team among hundreds of medical billing and coding companies. There are different costing types that you can choose. It can either be a flat fee or a percentage of the revenue collected. While comparing the quotes from a few vendors is vital for getting a reasonable price, you should also keep the quality of services in mind.

6.Compliance and Security Measures:

Compliance and security are the two pillars on which the credibility of the RCM companies stands. When dealing with bills, the billing professionals assigned to your account will access sensitive patient health information. Check multiple times whether they have proper IT systems to ensure PHI safety. HIPAA compliance is the security building block for medical billing and coding companies.

7.Claim Denial Management:

Despite taking all possible measures for a clean claim, you might find some claims getting denied by the insurance companies. Ask the companies about their median denial rate. According to surveys, more than 60% of billing professionals do not edit and submit the denied claim within the given time frame. Therefore it is incredibly crucial to know how your outsourcing partner will deal with these issues.

8.Technology Advancement:

Medical billing suffers from clerical and manual errors like coding mistakes or incorrect and inaccurate insurance details. These issues must be handled with better care with the help of correct software solutions to keep your revenue integrity strong. Know about the kind of tools your chosen medical billing company uses to ensure minimal errors in the billing process.

9.Customer Service:

Maintaining a good customer service record can be a deal maker for medical billing and coding companies. Leading RCM companies make sure that they keep their counterparts of the in-house team in the same loop so that there is no lag in information. Discuss the different ways of communication like chat, email, and call that you can expect from the billing teams. Having a responsive team for your queries will boost the organization’s efficiency.

10.Additional Services Offered:

Several RCM companies do not limit their services to billing and coding. They can also provide additional healthcare services like provider credentialing and customer service for EHR companies. If you are struggling with any other back-office issues in your organization, ask them if they have any other service offerings in these fields. Getting overall support from a credible RCM company could help you manage your business operations better.

Choosing among several potential vendors could be overwhelming for the business. However, with the help of the above steps, you can narrow your options down to the most suitable partner.

We hope this article helped you understand how you can choose the right partner among several medical billing and coding companies. Please connect with us in the comment section below in case of any queries. Subscribe to our blog for regular articles on the medical billing industry. Follow us on Facebook, Instagram, Twitter, and LinkedIn for more.