Role of Medical Billing Firms in Maximizing Medical Claim Reimbursement

Earlier, medical billing was something quite deterring to healthcare professionals with busy practices to run. Now, things have changed and medical billing has become smoother and swifter, thanks to billing services. Mainly, small / medium clinics and individual physicians are mostly benefited through billing services. However, large hospitals and healthcare centers are also benefited by the services of billing companies, as they provide cost-effective and hassle-free medical claim reimbursement services. This is why billing services are getting popular these days, among all healthcare entities. In this article we will look at the benefits of hiring a billing services provider.

100% Satisfying Claim Management with Medical Billing Outsourcing

The medical claims submitted to insurance payers have to be accurate in all respects if you are to receive correct reimbursement. Checking the insurance papers and getting the claim amount from the insurance companies through regular follow-ups can be time consuming, as well as budget intense. Mainly, small healthcare clinics may not have a separate accounts department, as it is cost consuming. On the other hand, handling the claims can be time-consuming as you need to follow-up with the insurance companies regularly for the claimed money disbursement.

From claim management to billing and coding, according to the laws of states, a billing company renders all the required services. Here are the services that you can avail of from a reliable billing company:

• Checking the patient's insurance terms and conditions and investigating the validity of the insurance papers. This will lead to easy payment reimbursement from the insurance companies.


• Following up with the insurance companies at a regular interval to make sure that there are no unnecessary delays in payment disbursement.


• Handling the situation efficiently, when a claim has been denied. Competent providers of billing services follow up on denied as well as delayed claims, making the necessary modifications and providing valid information. They make sure that their clients receive maximum reimbursement.

Expand Your Business - Provide High-end Services

For a healthcare unit, seamless healthcare management and cutting edge services for the patients are the main objectives. This will help the clinic to become popular and thus, provide a chance for business expansion. With billing outsourcing, management teams of small healthcare clinics get more time and peace of mind to think about providing better services to their clients. They can focus more on quality services, without having any sort of anxiety regarding the payment.

Medical billing firms thus have an important role to play in helping their clients maximize claim reimbursement. Their value-added services will help healthcare entities eliminate those costly errors in billing and coding. Accurate claims will bring accurate reimbursement and help in maintaining a steady revenue cycle.

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Physicians to Manage Revenues amidst the Impending 26.5% Medicare Cut with a Medical Billing Service

Ever since Sustainable Growth Rate (SGR) began overshooting budgeted Medicare spend, physicians have been under the constant threat of Medicare cut. While Congress’ intervention has delayed the inevitable thus far, it may be a little tougher this time – Centre for Medicare Services (CMS) has already indicated that its fee schedule for 2013 is designed to initiate 26.5% Medicare cut if the Congress fails to intervene before Jan. 1, 2013. While physicians may still be optimistic of a breakthrough in their favor, they still need to be prepared for any eventuality. And if 26.5 Medicare cut is indeed set in motion, it would have a debilitating effect on physicians’ clinical and operational efficiency – practices may not be able to support operational expenditure, leave alone the thought of ‘profit’.

Despite the looming fear, practices can still find ways to off-set the impact of Medicare cut – transition to new payment and delivery models will help meeting the primary objective of improving patient care as well as moving to a higher-performing Medicare program.

Accountable Care Organization (ACO) is one such care model, which will increasingly become mandatory for care providers in the Medicare network. ACO requires physicians to form a clinical network that can achieve optimum clinical efficiency at minimum cost to patients. ACO works on the formula that a clinical network with A-Z medical services can considerably bring down patients’ medical expenditure. While physicians in an ACO get to be recognized for high performance, they also stand to benefit from shared-savings. Moreover, being in an ACO is indeed helpful in building credibility among patients.

The provision of Affordable Care will also help physicians counter the impact of Medicare cut. The significant thing about this reform is that it extends Medicare to every uninsured citizen in U.S. With roughly one-third of population expected to be Medicare beneficiaries, physicians can look forward to off-set Medicare cut with operational volumes from Affordable Care provision. But transiting to these novel care models may be seemingly difficult for physicians who have been used to protective health care models. Amongst possible challenges, understanding fee schedule, negotiating and renewing payer contracts, being conversant with multiple payer policies, and striking beneficial deal with payers will be more important. Moreover, a proper mix of public-private payers is more than advisable.

And, amidst these Medicare-cut-generated challenges, mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding too will add to the burden, which may be far too much to bear for physicians. With the in-house staff incapacitated to take responsibility of this enormity, outsourced medical billing services seem to be the only way out. Medical billing companies – with experience and competence in stage-managing transformation to high-performance Medicare models, managing mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding on behalf of physicians who are essentially focused on clinical efficiency – could provide helping hand.