Your Essential Guide for Selecting a Medical Billing Company in the US

medical billing company in US

The benefits realized when a healthcare practice outsources medical billing is not a secret. The growth in the medical billing services industry, 11.56%, testifies to this statement. But once you start researching, you will find that choosing a medical billing company in the US is not as straightforward as you would’ve imagined.

As the industry demand continues to increase, so does the number of new billing companies. But with so many medical billing companies in the market, how do you choose a quality medical billing company? This blog will provide an 8-point guide to help you select the best medical billing company for your practice.

medical billing company

8 Factors to Consider When Choosing a Medical Billing Company in the US

1. Experience and Reputation

As the U.S. medical billing outsourcing market is expected to grow at a compound annual growth rate (CAGR) of 11.56% from 2023 to 2030, many new companies can start up to take advantage of high market demand. Many new companies will not have the expertise to deliver on their promises.

When selecting a medical billing company, it is essential to check their experience and reputation. Look for companies with a proven track record of success in the industry for several years. You can check their reputation by looking for online reviews or asking for references from other healthcare providers. A company with a good reputation will have a higher chance of providing quality services that meet your expectations.

medical billing company in US review

2. Billing Company Size

After investigating the company’s reputation and feeling satisfied with its credibility, you need to ensure that its size suits your needs—many medical billing companies in the US work on a small scale.

If your practice is small with little data to manage, then a small medical billing company would be a good fit. But smaller companies might fall short of delivery expectations if you plan to scale or already have quite an extensive operation.

Larger medical billing companies with an international footprint, like Neolytix, offer additional benefits like round-the-clock availability and a higher level of expertise as they can research market and legislative changes and continuously upskill their personnel.

3. Expertise in Your Specialty

Each medical specialty has its billing requirements, so choosing a medical billing company with expertise in your thing is crucial. For instance, a company specializing in pediatric billing may not be the best fit for a dermatology practice.

Ask the company about their experience in your specialty and what billing software they use. This brings us to our next point.

4. Billing Software

Medical billing companies use different types of software to manage their billing processes. Here are some of the most common billing software platforms that most medical billing companies in the US should be familiar with.

Most Common Medical Billing Software Platforms in the US

Kareo

Kareo is a cloud-based medical billing software that is popular among small and medium-sized practices. It offers features such as patient billing, insurance billing, revenue cycle management, and reporting.

AdvancedMD

AdvancedMD is a web-based medical billing software that offers features such as electronic health records (EHR), practice management, revenue cycle management, and patient engagement.

Athenahealth

Athenahealth is a cloud-based medical billing software that offers features such as billing and collections, EHR, practice management, and patient engagement. It is a popular choice among larger healthcare organizations.

Epic Systems

Epic Systems is a web-based medical billing software that offers features such as EHR, practice management, revenue cycle management, and patient engagement. It is a popular choice among larger healthcare organizations.

NextGen Healthcare

NextGen Healthcare is a web-based medical billing software that offers features such as EHR, practice management, revenue cycle management, and patient engagement. It is a popular choice among larger healthcare organizations.

Ensure that your chosen company uses billing software compatible with your practice management system. This will make it easier for the medical billing company to integrate with your practice and reduce errors in billing.

5. Billing Process and Denial Management

The billing process of a medical billing company should be transparent and efficient. Inquire about their billing process, including how they submit claims to insurance companies, follow up on denials, and handle patient billing inquiries. Ensure they have a system for tracking shares and following up on denials promptly.

Collaborating with a medical billing company with a competent denial management team is one way to manage denied insurance claims effectively. It’s essential to inquire about their assistance if claims are denied.

6. The Pricing Model

What is the going rate of medical billing services
The pricing model of a medical billing company can vary widely. Some companies charge a percentage of the collections, while others charge a flat fee. The table below summarizes the five most common pricing models of medical billing companies in the US.

Pricing Model Options of Medical Billing Companies in the US

Pricing Model Type
Description

Percentage of Collections

Based on a percentage of the total collections received by the medical billing company on behalf of the practice. Typically, the percentage ranges from 5% to 10% but can vary.

Flat Fee

Involves charging a fixed fee for the medical billing services provided. The fee may be charged on a per-claim basis or a monthly basis, and it can vary depending on the complexity of the services provided

Per Claim

Entails charging a fixed fee per claim submitted to insurance companies. The fee may vary depending on the complexity of the claim, such as the number of services provided or the type of insurance plan

Hybrid Model

This model combines elements of both the percentage of collections and flat fee models. The medical billing company charges a flat fee for basic services, such as claim submission and follow-up, and a percentage of collections for more complex services, such as appeals and denials management

Hourly Rate

Centered around charging a fixed hourly rate for the medical billing services provided. The rate may vary depending on the level of expertise required and the complexity of the services provided.

It is essential to understand the pricing model and ensure transparency. Remember to ask about hidden fees or charges not included in their initial pricing quote.

7. Regulatory Compliance

The healthcare industry is highly regulated, and medical billing companies must comply with several regulations. Ensure that the company you choose complies with HIPAA and other relevant laws. Ask about their policies for protecting patient data and how they ensure their employees are trained in compliance.

8. Customer Support

Finally, choosing a medical billing company with excellent customer support is essential. Inquire about their availability and response times, mainly when billing errors or issues occur. In case you missed it earlier, the company’s size and international footprint may influence its customer support and availability level.

Ensure they have a dedicated customer support team to address your concerns promptly.

8 Factors to consider when choosing a medical billing company in the US

1. Experience and reputation

Many new billing companies in the US make promises they can’t keep.

2. Billing company size

The size of the company could indicate the quality of service and reliability.

3. Expertise in your specialty

Ask the company about their experience in your specialty.

4. Billing software

For the medical billing company to integrate with your practice with ease.

5. Billing process and denial management

Ensure that they have a system in place for tracking claims and following up on denials promptly.

6. The pricing model

Understand the pricing model and ensure that it is transparent

7. Regulatory compliance

Compliancy with HIPAA regulations and any other relevant regulations.

8. Customer support

Availability and what contingency plans are in place for emergencies?

Your Best Choice for Selecting a Quality Medical Billing Company in the US

In conclusion, selecting the right medical billing company is crucial for the success of your practice. Neolytix’s team of billing and coding experts has extensive experience, gained over 11 years of servicing practices of all sizes and specialties in all 50 states, using industry-best billing software to ensure accuracy and efficiency.

Contact us today to learn more about our services for medical billing and coding and how we can help your practice grow.

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