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APPLIED MEDICAL SERVICES: AMS News Room: Articles
Benefits of Contracting With An
Outside Billing Company
Have there been months when the collectible amounts
within your practice have been low? Months when your
reimbursement for services rendered cannot keep pace
with your expenses? If so, then you are not alone.
In a system dominated by HMO’s and PPO’s
it often requires a great deal of effort and expertise
to collect what is necessary to make your practice
profitable. Effort spent following up on insurance
denials and incomplete reimbursement. Effort that
most private practices do not have the manpower or
the requisite funds to expend.
Today it is becoming common for medical practices
to depend on outside service providers for their
billing needs. Hiring an outside agency has proven
to be a cost effective solution for various reasons.
First, it reduces your payroll and scheduling expenses.
It also eliminates the headache of finding qualified
personnel and the time spent training them. Apart
from the monetary savings, physicians utilize billing
companies to improve efficiency and to enhance employee
utilization within their office, thus increasing
their reimbursement level. A physician’s time
and effort should be directed towards the patient,
not towards the struggle with insurance companies
to obtain the highest level of reimbursement.
Selecting a qualified billing company should be
based on each practice’s specific needs. Importance
should be placed on finding an organization that
is well established and respected in the medical
billing industry. Experience is often the most important
step towards solidifying your billing procedures
and increasing your reimbursement. A billing company
must also take pride in hiring certified personnel
who keep up-to-date on the constantly changing rules
and regulations mandated by state and federal governments.
By understanding these regulations and their implications,
a practice will see a noticeable reduction in their
claim rejection rate, immediately increasing revenue.
A very important consideration when hiring a billing
company is location. It is often beneficial to hire
a qualified billing service located in or near your
own state. This will ensure the company you select
is familiar with the laws and regulations in your
area and will understand the best reimbursement methods
for your practice.
In addition to insurance claim handling and accounts
receivable management, several billing companies
also offer medical coding and auditing, documentation
training, consulting and full practice management.
Full practice management may consist of a number
of services including credentialing, contracting,
consulting and financial services. This will benefit
all medical providers from hospitals to small, private
practices.
HIPAA compliance is the hot topic in medicine in
recent months. A practice must choose a billing agency
based on whether the agency is compliant with the
national standards. Civil penalties can cost up to
$100 per violation and criminal penalties as much
at $50,000 per fine and one year in prison. All medical
practices, billing services and clearinghouses must
be HIPAA compliant by April 2003. Medical facilities
should begin the compliance transition now, rather
than delaying the inevitable. Outsourcing may make
the shift to HIPAA compliance easier by removing
some of the responsibility from the practice itself
by hiring a company that is already abiding by the
future mandatory national standards. Some websites
of interest for more information on HIPAA regulations
are www.nchica.org, www.healthprivacy.org, www.hcfa.gov
and www.hipaasummit.com.
Ms. Mitchell is the Billing and
Coding Manager for Applied Medical Systems, Inc.,
an accounts receivable management company in Durham,
North Carolina. Ms. Mitchell has over 10 years experience
in medical billing, coding and consulting. . For
any questions regarding the above editorial you may
reach Ms.Mitchell at (919)477-5152 or at rmitchell@ams-nc.com. |
