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Medical Billing Blog
Posted on November 6, 2014 by · Leave a Comment
Filed under: Medical billing outsourcing  

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Medical Billing Outsourcing Services

There are quite a few things to consider if you are a medical provider looking to outsource your medical billing and coding processes. It may be hard to choose medical billing services since you will be handing the control over the essential aspects of your job or practice.

Overview Of Medical Billing Outsourcing Services

Outsourcing your medical billing work has its own advantages; it helps you to concentrate on your job since you do not need to waste your time on medical billing works. However, when choosing a medical billing outsourcing service, you need to choose one that specifically serves your needs. Otherwise, it will be a big loss of money and time. Well, given below are few tips that will help you to choose the correct medical billing and coding services.

In order to maintain a successful relationship between physicians and their billing services, communication and transparency are the key factors. Try to make sure that the medical billing outsourcing services that you are opting for offering good communication policies, which will help you to communicate about your requirements with the service provider. Some of the questions that you need to consider are,

  • How they work insurance denials
  • Type of reports they run
  • Ensuring method of communication, i.e. whether it is through email, phone or chat

Medical Billing Outsourcing Services

Another thing that you need to consider while going for medical billing outsourcing is whether the medical billing service that you are choosing is making any changes to the medical billing codes like CPT, HCPS, and ICD-9 without your permission. If it does so, it is not recommended to continue with that specific service provider. An efficient medical billing service provider will find the errors that you have made in the medical billing codes and correct it. However, when doing so, first they need to consult you. This will help to prevent the liability issues in the future.

Using a medical billing service that files claims through an internet-based management system is one of the easy ways to feel a sense of retaining control and managing transition issues. Moreover, go for a service that bills on an emergency fee, since it is the most favored method of billing. It will be easier to judge your costs each month if you are going for a set dollar amount per claim.

These are the things that you need to look for when opting for medical billing outsourcing.

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We write quite a bit about the benefits of outsourcing your medical billing to a highly-qualified third party medical billing service. But we‘«÷re not the only ones; if you search on Google, you‘«÷ll find quite a number of articles on the benefits of outsourcing.

Here are a few of the greatest hits, which we think you‘«÷ll find useful.

As early as 1999, the American College of Physicians-American Society of Internal Medicine wrote about comparing inhouse and outsourced medical billing, citing the example of one doctor in Pennsylvania who began outsourcing the practice’s billing. Since then, he said, he was getting more money‘«Ųcollections had increased more than 30%‘«Ųand getting paid faster. ‘«£Those are the benefits of outsourcing billing operations that third-party billing companies like to tout: higher collection rates and fewer staff headaches,‘«ō the author states.

The article goes on to explain that the solution isn‘«÷t so simple for every practice, and that ‘«£mom and pop‘«ō medical billing services provide mixed results. We couldn‘«÷t agree more, and have written about that in several blog posts. That‘«÷s why we argue that a nationwide, multi-branch medical billing service is the best bet for improved revenue.

Next, medical billing software resource?ŠSoftware Advice published a popular article?Šon its blog,?ŠThe Profitable Practice. This article actually included a study done by the site, which came up with the following results comparing annual costs for both approaches:


Billing department costs $118,000 $4,000
Software and hardware costs $7,500 $500
Direct claim processing costs $3,600 $122,500
Software and hardware costs $5,500 $2,000
% of billings collected 60% 70%
Collections $1,370,900 $1,623,000
Collections costs $129,100 $127,000
Collections, net of costs $1,241,800 $1,496,000


Eye-opening, isn‘«÷t it? To think that you could reduce your collections costs and still collect more on an annual basis‘«Ųthat additional $254,000 to the bottom line is nice to have, in our opinion. Of course, that is once again predicated on the idea that you see an increase in your collections, which requires a medical billing service with experience and trained staff.

The article also provided some recommendations on factors that would spur a provider to consider outsourcing their billing, including:

– Your billing process is inefficient.

– You have high staff turnover.

– You’re not tech savvy.

– You’re a new provider.

– You have different priorities.

All good points‘«Ųwe agree that these are good reasons to consider outsourcing your medical billing.

Most recently, we have seen two articles published by Med City News on why outsourced medical billing may be the best option for many practices. In the first article, the author points out that ‘«£More than 10% of debts for a majority of providers go over four months and are unfortunately written off as bad debts. Medical billing services, on the other hand, are much feistier in their attempt to recover debts, often turning out to be successful in cases where in-house billing teams tend to fail. Therefore, providers facing outstanding debts for longer times have much to gain by outsourcing their billing to a renowned medical billing company to experience higher revenues and much shorter billing cycles.‘«ō

In the second article, the same author points out that ‘«£Your medical billing company will be contractually bound to perform some services, such as appealing denials which will eventually result in shorter billing cycles‘«™

‘«£Outsourcing medical billing services also results in a much lower claim rejection rate such that a medical practice can expect between 5% to 15% increase in the amount they are able to collect by opting for a billing service.‘«ō

We strongly agree with these statements, as we have seen these types of improvements repeatedly with our own clients. But we also agree with the idea above that it‘«÷s important to evaluate whether outsourcing your medical billing is right for your practice; only you can make that decision.

If you‘«÷d like to learn more about choosing the right medical billing service for your practice, download our free white paper, When and to How Select the Right Medical Billing Service. It‘«÷s full of checklists you can use to determine whether outsourcing your medical billing is right for you, and how to find the medical billing service that will provide the results you want.

You can also call us today at 800-966-9270 to talk with one of our expert practice revenue consultants, and they‘«÷ll be happy to discuss your needs and how we can help bring more to your bottom line.

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Many medical billing software/EMR companies are offering medical billing services as an add-on to their technology offerings these days, but is that really the best way to handle your revenue cycle management, the lifeblood of your practice? We don‘«÷t think so, and here are 5 reasons why.

1. You deserve freedom of choice when it comes to technology. If a technology company is handling your medical billing, guess who chooses the software you will use? They do! They can‘«÷t possibly know enough about your work flow and staffing to choose the right software for you, and why shouldn‘«÷t you have the freedom to choose what you prefer?

2. You deserve a medical billing service that is focused on getting you paid. I‘«÷ve worked in a software company, and I can tell you that the focus tends to be on the software and engineering new features in the software. Don‘«÷t you want a medical billing service that is focused on your revenue cycle management? Of course you do.

3. You deserve thorough follow-up on your claims. One technology company that provided medical billing services for a low rate neglected to tell its provider customers that the low rate didn‘«÷t include follow up on the claims‘«Ųthe company submitted the claims and that was it. You don‘«÷t need that kind of surprise!

4. You deserve real customer service. When you‘«÷re one of several thousand customers, it‘«÷s hard to feel like your business has any importance to your medical billing service, isn‘«÷t it? You want a medical billing service that makes you feel like your practice and your business is important to them‘«Ųpreferably one that provides you with a dedicated Account Manager just for your practice.

5. You deserve a medical billing service that will make sure your practice is ready for the changes coming at you: HIPAA changes as of September 23, 2013, ICD-10 as of October 1, 2014, and others as they arise. A medical billing service that focuses on revenue cycle management (and has for years) is up to speed on the regulatory changes and what it means to medical billing; will a software company be prepared? Don‘«÷t take the chance.

At, we offer all of these benefits and more. With five locations nationwide that offer more than five decades of collective top management experience in medical billing services, we have the depth and breadth of experience to get your claims paid.

Plus, allocates over 50% of its billing costs to the successful collection of the last 20-30% of charges that typically do not get paid on first submission. We want to make sure you receive payment for every claim, and that‘«÷s why we say on our home page, ‘«£Every claim paid. Guaranteed.‘«ō

And to make you comfortable with the whole process, we provide you with a dedicated Account Manager who works closely with your practice and understands your unique concerns and challenges.

Why not find out how we can help you bring more to the bottom line? Contact today at 800-966-9270 or email

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That‘«÷s right‘«Ųmy medical billing service beats your inhouse billing staff. Well, not literally‘«Ųbut in the things that matter, yes, our third party billing service can beat inhouse staff hands down on most points.

Here‘«÷s why I say that:

1. You only pay for our billing services when you‘«÷re actually using them. You don‘«÷t have to pay us whether or not you have claims to bill, whether or not we are sick or on vacation. And you only pay us when you get paid. That‘«÷s a pretty efficient way to run your medical billing.

2. Our medical billers are highly trained and expert in medical billing. Medical billing is what our billers do, every day, all day. We hire only highly trained billers, and we make sure they stay up to date on their training. Plus, they learn from each other‘«Ųtheir colleagues in our offices across the country who are handling just about every specialty.

3. Our medical billers are up to speed on all the latest requirements and software. We make sure they‘«÷re up to date on HIPAA, CPT coding changes and other important legal issues. And they are trained on multiple software platforms. Because if we don‘«÷t, we are out of business.

4. Our medical billing staff will provide you with reports you can trust, and that have been proven to work for hundreds of other practices. We follow best practices across our multiple locations, and learn from what our experience managers throughout the company are doing. Reports are developed and refined to insure they are providing you with the information you need to manage your practice. And if you need different reports, tell us‘«Ųwe‘«÷ll work with you to get you what you need.

5. We save you all the hidden costs of hiring and maintaining a billing staff inhouse. ?ŠHiring and maintaining a billing staff has multiple hidden costs you probably don‘«÷t think about:

A. Medical Billing Specialist’s Employee salary

B. Medical Billing Specialist’s Employee benefits

C. Worker’s compensation


E. Healthcare insurance

F. Vacation, sick leave, etc.

G. Performance bonus

H. Computer hardware purchase & maintenance

I. Software purchase & renewal

Do what you do best. Let us handle the rest.

You didn‘«÷t go to medical school to learn how to manage medical billing staff; you wanted to treat patients. Why waste your valuable time on administrative details better outsourced and left to the experts?

Here‘«÷s what one of our customers said about making the change:

‘«£ made all the difference for my practice. They eliminated all the frustrations associated with insurance reimbursements and increased my revenues by 100%.‘«ō

Why not find out how you can reduce your headaches and increase your bottom line? Contact today at 800-966-9270 and talk to one of our practice revenue consultants about how we can improve your practice profitability.

We‘«÷d love to show you how we can beat the results your inhouse medical billing staff is getting.

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Medical billing service adsWhen you search for ‘«£medical billing services‘«ō on Google, it may seem like you‘«÷re being deluged with information‘«Ųand you may feel like you have no way to sort through what you‘«÷re seeing.

There are quite a few medical billing companies listed for any search‘«Ųso how do you find the right one for your practice? Here are a couple of tips for looking at Google ads:

1. Look for reviews. As you can see from our listing, we have more than 30 reviews from customers linked to our Google listing. These reviews give you a good idea of how well we‘«÷ve performed for practices like yours.

2. Notice what the ad says.?ŠOur ad plainly states, ‘«£Every Claim Paid. Guaranteed.‘«ō We put our guarantee in print, right at the top of our ad, because we mean it. And we stand by it.

3. Placement matters. Being one of the top ads on the left side of the page says that the company is large enough to commit some significant dollars to advertising‘«Ųand that‘«÷s a good thing if you want a medical billing service that will be around for a while (and you do). Having a medical billing service with resources and a commitment to the field will serve you in the long run.

Once you‘«÷ve called the number in the Google ad, notice a couple of things:

A. Does the representative on the phone seem to understand medical billing? If not, how can they match you with the service you need? If it‘«÷s a call center or the person just wants to close a sale without understanding your needs, beware. You want to deal with a medical billing service that understands and works to meet your requirements, and that starts with the first contact.

B. Does the representative give you a proposal in writing? Percentages and service level promises mean nothing unless they‘«÷re written down. Make sure you get all of your specified needs in writing in the proposal, so you know what the pricing includes.

C. Will the representative quote you real prices? In the beginning, of course, the rep needs to understand exactly what your needs are and how the medical billing service can meet them. But at some point the rep needs to be willing to quote you a price that includes what you‘«÷re looking for. And once you have a written proposal, you can compare that with what the services and price you are currently receiving. Otherwise, you don‘«÷t know what you‘«÷re comparing.

D. Can the representative answer your questions about denial rates, appeal success and other key performance indicators? Make sure you‘«÷ll be receiving the level of service that you need‘«Ųa high denial rate and low appeals success rate will slow down your revenue stream significantly. And how soon after claims are received by the medical billing service are they submitted? Data will help you choose the best revenue cycle management partner for your practice.

When you‘«÷re looking for the best medical billing service for your practice, be sure to consider these questions.

And for more tips on when and how to select the right medical billing service for your practice, download our white paper with checklists and useful advice now.

Or, call now at 800-966-9270 and we‘«÷ll be happy to answer your questions on improving your practice profitability.

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Is your practice ready for the influx of patients expected with the launch of healthcare insurance exchanges mandated by ACA for Jan. 1, 2014??ŠFourteen million U.S. residents will join the ranks of the newly insured on Jan. 1, 2014, according to the Congressional Budget Office.

‘«£Definitely!‘«ō you might think‘«Ų‘«£I‘«÷m ready for more revenue.‘«ō

Yes, but what about your practice: your staff and your processes? Are they ready?

Right now your office probably chugs along fairly well (or maybe not‘«Ųyou decide). But if the volume of patients you‘«÷re seeing increases rapidly, what will happen to your systems?

– Will no shows go through the roof because staff doesn‘«÷t have time to make reminder calls?

– Will patients wait interminably because check-in isn‘«÷t smooth (and meanwhile, your Yelp ratings plummet)?

– Will you be seeing patients whose coverage isn‘«÷t confirmed because staff didn‘«÷t have time to verify eligibility? (And not everyone will be covered, in spite of the mandate.)

– Will your denial rates rise and your appeal success drop because billing staff are simply overwhelmed?

These are all possibilities‘«Ųif you don‘«÷t review your office processes now, tighten up where needed and plan ahead for the increase.

Here are some steps you should take now:

1. Do an audit of your office. Where are the bottlenecks? How can they be eliminated?

2. Verify eligibility electronically. If you‘«÷re not already verifying eligibility electronically, there will never be a better time to make that change. You can‘«÷t afford having staff spend hours on the phone or even an hour visiting different insurers‘«÷ websites‘«Ųthey need a one-stop method of checking. Many billing software solutions offer this now, and your staff will need it.

3. Take patient histories electronically. By taking patient histories electronically via a patient portal or a tablet in the office, you‘«÷ll reduce wait times for patients (a major source of dissatisfaction) and eliminate the need for a staff member to enter the data into the EHR. This is vital with an increased patient flow; if you have patients sitting, filling in patient histories by hand, your scheduling is going to be shot within the first 2 hours. And you know many of them will forget to fill in the patient history ahead of time or forget to bring it if they do fill it in.

4. Use electronic check-in. Either through a patient portal or in-office kiosks, you need to have patients check themselves in. This will save your front office staff a great deal of time and reduce waiting time. It also offers patients the opportunity to cancel and reschedule easily in advance‘«Ųwhich means you won‘«÷t have holes in your schedule you have to juggle at the last minute.

5. Evaluate your billing processes. With more patients to bill and file claims for, your billing staff could easily be overwhelmed. Then think about the denial management and appeals‘«Ųwill your staff be able to handle the increased volume? Plus get ready for ICD-10?

Even if your billing staff is able to handle the volume of billing your practice currently sees, with the increased number of patients, they may soon be overwhelmed. Plus, they may be seeing new types of denials and problems as payers sort out how they‘«÷ll handle the new coverage.

That‘«÷s why now may be the time to consider turning to a medical billing service‘«Ųan organization that will be up to speed on all of the new regulations and requirements, able to staff up quickly and handle the increase in claim volume. This is what a medical billing service‘«Ųparticularly a nationwide medical billing service like‘«Ųdoes every day.

Find out how we can insure that your medical billing runs smoothly‘«Ųand brings more to your bottom line‘«Ųeven in the face of changes such as the health insurance exchanges and ICD-10.

We‘«÷re ready; we‘«÷ll make sure you‘«÷re ready.

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Physicians Practice, a site I admire and read frequently, recently posted an article entitled ‘«£The Case for Outsourcing RCM at Your Medical Practice.‘«ō The post made some excellent points, which I have also made on this blog, about the fact that with so many regulatory and coding changes affecting medical practices, billing and collections is getting more challenging for physician practices.

We couldn‘«÷t agree more.

What we disagree with, however, is the concept behind the case study presented in the article. The article profiles a practice that made the wise decision to outsource their medical billing‘«Ųbut they did so with a company that essentially provides medical billing as a sideline to their normal business.

Why would a practice do that, you ask?

It‘«÷s because many companies that produce medical billing software are now offering medical billing services. Practices see these companies as safe options since they have used the software successfully.

This is like asking GoToMeeting to run your next all-staff meeting. Or having Microsoft write your next practice brochure.

Medical billing is not what these companies do; it‘«÷s what they facilitate with software.

We spoke recently with a practice owner who told us that they had done this, and found that while they were only paying 4% for their medical billing, the company neglected to tell them that they were not following up on claims! As a result, the practice has found that they‘«÷re collecting approximately 42% of what‘«÷s owed to them.

Are you willing to accept only 42% of what you‘«÷re owed? I hope not!

That‘«÷s why, when it‘«÷s time for you to outsource your medical billing, it‘«÷s vital to carefully evaluate your medical billing partner and make sure you get the right one for your practice.

Here are some key questions to ask:

1. Does the company have enough experience in medical billing to know how to get your claims paid‘«Ųhow to follow up, file effective appeals, etc.?

2. How well trained is their staff? Do they have practical experience with medical billing?

3. Is medical billing going to be the primary focus of your partner? If they‘«÷re worried about getting their next software release out and pull some of their medical billers to test, what will be the effect on your revenue?

4. Make sure you know what you‘«÷re getting: Will the claims be followed up on? Will the follow up be effective?

5. What kind of customer service will your practice receive? With a larger company focused primarily on software development, will your practice (particularly if it‘«÷s smaller) receive the attention you need and deserve?

6. What is the company‘«÷s overall success rate with medical billing? What type of service level agreement are they willing to give you on your claims (not your software!)?

There are many more points to consider when you evaluate a medical billing partner, and that‘«÷s why we recommend that you get our free white paper, When and How to Select the Right Medical Billing Service.

Just a few of the key items you‘«÷ll get are:

– A 30+ point checklist for evaluating a medical billing service

– The different types of medical billing services and the advantages/disadvantages of each

– Medical billing service pricing–how it works and what you get for your percentage/fees

– And more

Make sure you get what you need for your practice to protect your revenue. A Johnny-Come-Lately medical billing software company may not be it.

Tagged Under : , , is pleased to announce that we now have several free resources available for medical practices seeking to improve their practice revenues. In response to the needs of our customers and medical practices we have talked with, we have developed a series of useful, in-depth white papers including:

1.?Š?Š?Š?Š?Š?Š How to Improve Your Medical Practice Bottom Line: Medical Billing, Key Performance Indicators and More

How to Improve Your Medical Practice Bottom Line white paperWith the pressures of the sequester cut, reduced reimbursements and other changes in the healthcare world, many practice owners are looking for ways to bring more to the bottom line. In this practical white paper, expert Owen Dahl outlines methods for improving your revenue cycle results:

-?Š?Š?Š?Š?Š?Š?Š?Š?Š How to develop Financial and Collections Policies that work

-?Š?Š?Š?Š?Š?Š?Š?Š?Š Key steps in handling delinquent accounts that will help you collect

-?Š?Š?Š?Š?Š?Š?Š?Š?Š The 3 Key Performance Indicators you MUST track carefully to insure profitability

-?Š?Š?Š?Š?Š?Š?Š?Š?Š And more

Download your copy now.

2.?Š?Š?Š?Š?Š?Š How to Prepare for ICD-10 in Medical Practices: Overview and Checklist

How to Prepare for ICD-10 in Medical Practices white paperThe deadline for ICD-10 implementation is October 1, 2014, and CMS has indicated that they will not be delaying it again. Whether you‘«÷ve started your ICD-10 conversion or are just starting to think about it, expert Betsy Nicoletti offers key tips you can use in this white paper overview. She includes checklists and resources that will make your transition easier and help you avoid bumps in the road, including:

-?Š?Š?Š?Š?Š?Š?Š?Š?Š Assessing ICD-10 readiness and setting up a plan, timeline and budget

-?Š?Š?Š?Š?Š?Š?Š?Š?Š Determination of responsibility for assigning ICD-10 codes and sequencing them according to guidelines

-?Š?Š?Š?Š?Š?Š?Š?Š?Š How ICD-10 differs from ICD-9 and how to assess what it means to your practice

-?Š?Š?Š?Š?Š?Š?Š?Š?Š And more

Download your copy now.

3.?Š?Š?Š?Š?Š?Š When and How to Select the Right Medical Billing Service

How to Select the Right Medical Billing Service white paperHow and when to utilize a medical billing service for your medical billing is a key question for medical practices, and selecting the right medical billing service for your practice and specialty is vital to your success. Learn what you need to know about the different types of medical billing services, how to evaluate seven key criteria for choosing the right medical billing service, pricing models and how they work, and much more:

-?Š?Š?Š?Š?Š?Š?Š?Š?Š A 30+ point checklist for evaluating a medical billing service

-?Š?Š?Š?Š?Š?Š?Š?Š?Š The different types of medical billing services and the advantages/disadvantages of each

-?Š?Š?Š?Š?Š?Š?Š?Š?Š Medical billing service pricing–how it works and what you get for your percentage/fees

-?Š?Š?Š?Š?Š?Š?Š?Š?Š And more

Download your copy now.

4.?Š?Š?Š?Š?Š?Š Starting Your Medical Practice: Medical Billing, Key Performance Indicators and More

Starting Your Medical Practice white paperWhen you‘«÷re starting a new medical practice, of all the decisions you need to make, how you handle your medical billing may be most key to the long-term success of your practice. You didn‘«÷t go to medical school to learn medical billing, so rely on this practical guidance from expert Owen Dahl, consultant to many medical practices and former owner of a medical billing service. He will outline the key points you need to know to insure success:

-?Š?Š?Š?Š?Š?Š?Š?Š?Š How to structure and manage your medical billing process for maximum return

-?Š?Š?Š?Š?Š?Š?Š?Š?Š Key steps in handling delinquent accounts that will help you collect

-?Š?Š?Š?Š?Š?Š?Š?Š?Š The 3 Key Performance Indicators you MUST track carefully to insure profitability

-?Š?Š?Š?Š?Š?Š?Š?Š?Š And more

Download your copy now.

In addition to these resources, we will continue providing useful articles on this blog each week‘«Ųcheck in frequently to find news, tips for increasing your revenue, and more. If there are subjects you‘«÷d like to know more about, just let us know by writing in the comments box on this blog.

And when you want to speak to an expert about particular medical billing challenges you‘«÷re facing, give us a call at 800-966-9270 or email We‘«÷re ready to answer your questions and help you achieve the success you deserve.

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If you‘«÷re setting up a new medical practice, whether you‘«÷re leaving another practice or fresh out of school, you probably have a lot of questions about how to manage the financial aspects of your practice. After all, you didn‘«÷t go to medical school to learn revenue cycle management.

To help you with this vital process, we asked expert Owen Dahl to outline the basics of revenue cycle management, which he did in our new white paper, Starting Your Medical Practice: Medical Billing, Key Performance Indicators, and More.

The Revenue Cycle

The revenue cycle (RC) consists of three major areas of emphasis. This workload is like an assembly line. The front desk must complete its tasks of account set up before the encounter form can be generated by the clinical staff, which all needs to be completed prior to the insurance claim being submitted. Even though each step is necessary, the volume of work involved in the RC is heavier on the processing side than any other, and all parts must work together. In Figure 1 below, please note the approximate percentage of work effort required to manage the RC by the key areas. The chart is an estimate of the ‘«£normal‘«ō relationship between these major areas. There is no real scale that indicates which is more important: all are absolutely necessary.

Approximate % of Work Effort to Manage Revenue Cycle by Key Areas

In order to meet the demands of proper management of the RC, it is necessary to address it as a complete process and not to look at just one part. One part cannot be fixed and assume that things will improve across the board. Too often fixes are a result of a quick look at one part of the RC, and changes are made that realistically won‘«÷t solve the problem.?ŠIn fact, greater issues often surface in this scenario. For example, a denial report states that patient demographics are the reason for most of the denials. Although it looks like the problem lies with the receptionist, in reality, there may be many issues that caused the denials and not just the capability of the staff. Staff training, lack of delineation of tasks and proper staffing at the front desk could all have contributed to the number of denials. But the issue would not have surfaced if there was not a report from the processing section indicating that there were errors in that area. All component parts of the RC must work together.


Model Revenue Cycle for a Medical Practice



















Following are the basic duties that reside in each of the three sections of the RC:

Front desk

  • Patient scheduling
  • Patient demographics
  • Insurance information
  • Verify insurance coverage
  • Collection of co-pay, deductible and previous balances
  • Obtain authorization for services if necessary


  • Complete encounter form
  • Identify level of service, diagnostic and/or treatments performed with description or CPT code and diagnosis code
  • Charge entry through connected electronic health record


  • Charge entry from completed (encounter form if charge form not done by the physician or clinic staff)
  • Code review
  • Submit claims through clearinghouse
  • Review unclean claims, repair and resubmit
  • Receive explanation of benefits (EOB) and funds
  • Process payment
  • Identify denial and appeal needs from the EOB
  • Appeal claims as necessary
  • Re-file claims for underpayment
  • Process patient statements
  • Update patient account on status of payment
  • Process patient account to final disposition, e.g., payments complete, write off or turn to outside agency for assistance

Thus, we can see the complexity and potential for errors throughout the process. The ‘«£assembly line‘«ō must work like a well-oiled machine to eliminate errors and to achieve the desired bottom line.

Learn more about effectively managing your medical billing‘«Ųrequest our free white paper now and you‘«÷ll get more information on developing financial and collections policies that work for your practice, the key performance indicators you must track to maintain and improve profitability, and more.

And when you are looking for an expert team to help you manage your medical billing, contact at?Š800-966-9270. Our billing management team has more than 50 years of combined experience in medical billing and coding and is ready to help you make sure you are bringing the maximum to your bottom line.


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As if medical practices weren‘«÷t already facing enough challenges, with ICD-10, EHRs and other acronyms, now you have a new wolf nipping at your heels: the ‘«£sequester‘«ō cut of 2% off of your Medicare fees.

In a recent article in Becker‘«÷s Hospital Review, David Borenstein, MD, FACP, FACR, Clinical Professor of Medicine at The George Washington University Medical Center and Former President of the American College of Rheumatology, said ‘«£The sequester will have an immediate and long-term effect.

‘«£Although Medicare [beneficiaries are] not affected, physician fees will be reduced by 2 percent across the board. This amount can have a detrimental effect on medical practices that have a significant proportion of Medicare patients. [This] limits the ability of physicians to obtain the expansion of staff and infrastructure to take care of patients.‘«ō

The article features 7 healthcare experts discussing the effect on various aspects of medical care, and the bottom line for most segments, and especially for physicians, was: This additional cut is going to hurt.

Who would think otherwise?

On top of the added expense of transitioning to ICD-10, with its training and other costs, and the implementation of EHRs, which many practices are undergoing right now with a commensurate decrease in productivity and profitability, the sequester is one more blow to an already staggering giant.

So what is the one thing you need to do to survive these challenges?

It‘«÷s simple but important: Make sure your revenue cycle management is as efficient as possible.

Your medical billing team must:

Even though you may think you have no time for it, it‘«÷s vital that you audit your medical billing processes as soon as possible with these 3 items in mind. Ask these key questions:

  • What is our baseline denial rate?
  • What categories do our denials fall in?
  • What steps can we take to reduce those denials‘«Ųretraining, batch verification of eligibility, other?
  • How effective are our appeals, in terms of percentage overturned?
  • Are our appeals timely, well-researched and as thoroughly documented as they should be?
  • Is our Collections Policy up to date and communicated to our patients?
  • Do we collect from patients before they see the provider, since our chances of collecting afterward drop to less than 40%?
  • Do we offer multiple options for payment, and ask for payment in a way that leaves no doubt payment should be made at the time requested?

But perhaps the most important question you should ask yourself is, ‘«£Do I have the right medical billing team for my practice needs in these challenging times?‘«ō

Now is an excellent time to evaluate and determine whether your practice is being served as well as it should by your current medical billing team, whether internal or external. It‘«÷s not uncommon in business to find that an organization has outgrown the original or most recent iteration of a function; in healthcare this tends to be the billing person who started out as a receptionist and did a fine job for a long time, but is now over her head. It can also be the small medical billing firm that can‘«÷t keep up with the increased demands from the growth of your practice.

If you would like to explore a different option for your revenue cycle management, consider a national firm with local branches for optimal customer support:

Contact us today at 800-966-9270 to learn how we can get you paid faster than 75% of multi-specialty group practices nationwide as surveyed by the Medical Group Management Association and Healthcare Billing Management Association for Days Revenue in AR.

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