Taking Full Advantage of Electronic Payor Systems

Electronic payor systems are growing in popularity as the medical billing industry adapts to an increasingly paperless world.  Today’s major payors, such as UnitedHealthcare and Aetna, offer completely electronic solutions for submitting and managing claims, reimbursement, and provider/administrative solutions.  Some of the most well-known of these online systems are OptumNavinetAvaility, and many more.

There are numerous benefits to taking advantage of these systems.  These include, but certainly aren’t limited to:

  • Claim Status:  A number of these electronic solutions, such as Optum and Navinet, allow for identifying claim status (e.g. pending, adjudicated, paid, or denied).  This cuts down on calling time and allows for instant verification of claims receipt and where the claim stands with the payor.  This feature significantly cuts down on time wasted waiting to speak with insurance representatives and provides more substantial evidence of claims receipt and status.
  • Appeals & Claims Corrections:  Gone are the days of paper appeals and claims corrections.  Numerous payors allow for online appeal submission and claims corrections.  Submitting appeals and claims corrections electronically/online allows for better tracking of these submissions and faster processing time.  As a medical billing company, we utilize these functions on a daily basis.  Online access to appeals and claims corrections allows us to see in real-time what the status of these submissions are and if further work is needed.  It also decreases the amount of time spent calling insurance companies and waiting to speak to a representative, who may or may not have the information we need.  It also decreases the potential for “lost mail” or appeals that have been received, but are never even reviewed.
  • Electronic Remittance Advice (ERA):  In today’s world, we no longer have to wait for payments and explanation of benefits to be mailed.  Not only can we receive remittance advice through our online clearinghouse, but we can also obtain the original ERA from the payor’s electronic system.  This is especially useful for finding payments from payors, who may not submit ERAs through your chosen clearinghouse.  Even if ERAs are received through an online clearinghouse, the exact remit information may differ from what the actual payor ERA states.  It is important for medical billers to know where and how to access the original payor remits for purposes of follow-up and appeals.
  • Authorizations: Authorizations can be easily obtained and retrieved from numerous electronic payor systems.  Some systems even allow authorization verification for certain procedure codes.  Various insurance companies require that authorizations be obtained online.  This feature is especially useful for office staff and those responsible for obtaining authorizations.
  • Administrative Functions:  A number of these electronic systems will allow for a certain amount of administrative functions to occur online.  Some offer the ability to update provider information, which must be updated on a regular basis to avoid any delays in processing and payments for a particular provider.  It also allows for important letters and messages to be received that may otherwise take longer when received through mail.  Payor-provider communication is also possible on a number of these systems.  Utilizing this feature allows for more accurate record of communications, less time on the telephone, and quicker turn-around time.

Because most of these services are readily available and relatively easy to use, there really is no excuse for a medical billing team to not use them.  However, we still continue to encounter office staff, providers, and medical billing teams that do not utilize these systems to their fullest potential or at all.  This is true for large practices and small practices alike.  Avoidance of electronic payor systems not only wastes valuable time and resources (e.g. reimbursement), but it also increases the risk for not addressing follow-up in a timely fashion.

At MedPro Services, our staff is highly-aware of numerous electronic payor systems and will use them to the highest potential possible.  We have had incredible success with addressing appeals, finding claim status, correcting claims information, retrieving authorizations, communicating with payors, and updating provider information while utilizing these systems.  You can find out more about our relationship with a number of electronic payor systems here.

Is Your Data Entry Team Working for You?

The very first step in successful medical billing is having a reliable, educated data entry team.  Data entry is the first point at which the claims process begins for medical practices and is, arguably, one of the most important aspects of medical billing.  A medical billing team must have proven accuracy and extensive knowledge of the data entry process because without these things the practice runs of the risk of lost revenue and the potential for failure.

A poorly motivated, under or improperly educated, and inadequately trained data entry team is destined to make costly errors, resulting in huge initial revenue losses for the practice.  While most of these errors can be fixed during follow-up, it is best to avoid data entry errors in the first place because additional work does equal additional costs.  From my experience in medical billing, there are two main types of data entry errors:

  • Demographic errors.  Incorrectly entered data, such as names, insurance numbers, and dates of birth, can result in insurance denials, which can delay payment and result in additional work and resources.  To avoid such errors, have patient demographics prepared electronically, as handwriting is often difficult to read.  Require that the data entry team check all demographic information at least once before charges are entered.  Provide clear copies of patient identification and insurance cards (both the front and the back).  Having an intuitive clearinghouse, such as the Zirmed, may help to stop any of these errors from even reaching payors.
  • Coding errors.  Far too often, data entry errors occur at the time of charge entry.  This is most likely the result of having poorly trained and inadequately educated data entry clerks.  I want to emphasize that medical billing and coding certification does NOT equate expertise in medical billing.  Just because an employee has the credentials does not mean that he or she is a skilled medical billing expert.  Data entry in medical billing is not an easy trade and is a position that requires a strong skill set in the task at hand.  Because of the complicated nature of medical billing, charge entry goes beyond entering whatever information is presented on the superbill.  Providers make mistakes and even though most providers have extensive knowledge in medical billing, superbill errors still occur.  Ultimately, it is the responsibility of the medical billing team to ensure that all claims are being billed correctly and that charges are not simply copied from the superbill.  This skill takes training, education, and thought.  Some common coding errors are: missed or incorrectly used modifiers, inappropriate procedure codes, incorrectly coded diagnoses, place of service errors, and bundling errors.  Data entry clerks must be knowledgeable on claims coding guidelines.  This also includes billing appropriately, even when reimbursement will not be likely.  Coding charges incorrectly just to obtain reimbursement is illegal and could result in auditing.  As a general rule of thumb, provide the medical billing team with the medical reports, so that greater specificity and accuracy can be made when billing out charges.

MedPro Services’ data entry team is comprised of knowledgeable, highly educated staff with extensive expertise in the field.  We take the time to properly train our team on claims coding guidelines and ensure that all checks and balances are in place prior to claims submission.  As a team, we strive for continued education and obtaining current knowledge of claims coding guidelines.  Our staff is highly motivated in obtaining top revenue for our clients because if our providers are losing money, then so are we.  For more information on our data entry services, please visit the data entry section of our website.

MedPro Services also offers consulting.  Our consultation services can help you determine if you are getting the best possible outcomes from your current medical billing department or company and can offer insights into potential areas of improvement, particularly in areas of data entry.  For more information on our consulting services, please visit our dedicated Consultation page.

Appeals Best Practices

Providers and medical billers are well-aware that insurance companies will not always pay every claim for the agreed upon rate and for reasons that vary across the board.  When denials or underpayments do occur, it is best practice to first identify if the claims issue needs appealing.  Because appealing is a lengthy and sometimes difficult process, it should be used as one of the final options in basic claims follow-up.  Prior to appealing, the following should be considered:

  • Correct billing:  Commonly, claims denials are the result of data entry errors.  Humans make mistakes and in an industry that relies on minimal human error to be successful, denials based on human error are, unfortunately, not uncommon.  Before appealing a claims denial, determine if the claim was billed cleanly and correctly the first time.  Common data entry denials might include errors in patient insurance information, bundling denials resulting from incorrect modifier usage, or missing information (e.g. referring doctor, accident/injury date, quantity).  Some questions to consider would be: Were the appropriate modifiers used?; Is there a mismatch between the CPT and diagnosis used?; Is any basic patient information missing on the claim?
  • CPT guidelines:  Following CPT guidelines is not always easy to accomplish.  Currently, insurance companies are not required to follow nationally recognized guidelines, such as CMS guidelines, making claims denials all the more difficult to bill cleanly initially and sometimes to appeal.  Even if correct CMS guidelines are followed when initially billing, sometimes insurance companies do not follow these guidelines.  If you are certain that a claim was billed correctly initially, then check the insurance payor’s provider billing or administrative guide.  These guides are usually available online.  If they are not, promptly request one from the carrier.
  • Payor/Provider contract:  Contracting with an insurance company sometimes requires that certain services will be paid at a specific rate and/or may not be billable at all.  Determine that contracted services are being billed and are being billed appropriately.  If contractual procedures are not being followed, then an appeal may not be possible.  It is important for the provider and medical biller to be aware of contractual requirements as well as contracted payor fee schedules to determine that the payor, as well as the provider, are following the requirements set forth by the contract.

When it is determined that an appeal is necessary, then the appeal should be completed promptly and correctly.  The appeals process varies from carrier-to-carrier, so your medical billing company should be well-versed in the appeals processes of common insurance carriers, such as UnitedHealthcare, Aetna, BlueCross and BlueShield (may vary by state), and Medicare (exact process may vary based on the medicare handler).

Most insurance carriers have a standard appeal time frame.  For some, it could be as soon as 45 days after the denial is received.  For others, it could up to a year.  Still for some, there may not even be a timely appeals filing limit.  It truly varies based on the payor.

The exact appeals process may also vary based on the carrier.  As of 2017, numerous insurance carriers, such as UnitedHealthcare and some Medicare handlers, offer the ability to appeal and monitor appeals online.  If an online/electronic means for filing a appeals is available, then the provider or medical biller should absolutely use this method to file an appeal.  However, even in our modern era, some insurance companies still require appeals to be faxed or mailed, making appeal tracking much more difficult, costly, and timely.  If an appeal is filed via fax or mail, your medical biller should follow-up within seven days of filing to ensure that the appeal was received and what the status of the appeal is.  Always maintain a “paper trail,” collecting reference numbers for every call, appeal document tracking numbers, and documenting all conversations with representatives, ensuring that names and employee id’s are documented.  Most insurance companies will have a timeframe for when an appeal will be complete.  The medical biller should continuously follow-up to determine if an appeal is being processed within that given timeframe.  Finally, copies of appeals should be kept for future reference in a secure location, such as a secure server or on a secure, HIPAA compliant online document storage solution.

The above information on appeals best practices are put forth by MedPro Services.  Our team follows these procedures and more, ensuring that our providers are getting paid on time and for what they are owed.  For more information on our A/R recovery and appeals solutions, visit our site here.

Welcome to the New MedPro Website

Over the past few months, we have been working on crafting a new and improved site, which details the services we provide and who we are as a team.  At MedPro Services, we pride ourselves not only in the quality of service we provide, but also in the personal touch that we can provide our clients.  We think that the new website provides more insight into who we are and what we do.

The new site highlights numerous categories, some of which are the actual services which we provide.  The following are some of the most commonly requested services:

  • Data Entry:  We pride ourselves in the accuracy and quality of our data entry services.  Data entry usually begins with demographic entry, at which point we ensure that all patient demographic information is accurate and current.  Our skilled charge entry team is knowledgable in current CMS, AMA, and ACA billing guidelines and incorporates this knowledge when entering client charges.  Not only are we familiar with various EMR/EHR solutions, but our billing software also has the capability of interfacing with numerous EMR/EHR platforms.  We also post payments for our clients and are experienced in utilizing electronic payment solutions (e.g. Change Healthcare, PaySpan) and our state-of-the-art clearinghouse, Zirmed.  At MedPro Services, it is our belief that data entry is the first step in ensuring our clients are receiving the best possible outcomes and highest revenue possible.
  • Clean ClaimsOur team is comprised of highly-skilled claims representatives, who are aware of the multiple means for submitting claims, the filing preferences of various insurance carriers, and the limits for timely filing, an aspect of insurance claims filing that varies from carrier-to-carrier.  We use a multi-tiered process for scrubbing claims and ensuring that claims are submitted cleanly upon first submission.
  • A/R Recovery: Something that sets us apart from the competition is our focus on A/R recovery.  Each claim, no matter the dollar amount, is important to us and to our clients.  If A/R is neglected, then the client is missing out on high potentials for revenue.  Some of our competitors strive for “easy money,” which is the revenue obtained by simply submitting claims and not following-up on those that did not pay.  This method results in high-profit margins for the billing service, but severely affects the client’s bottom line.  At MedPro, we follow up on all claims, all the time and have a proven record of increasing client revenue by as much as 30% within the first 3-6 months.
  • Credentialing & ConsultingBeyond the traditional medical billing services, we provide credentialing and consulting services as well.  Credentialing is one of the more difficult aspects of running a practice.  It is time consuming, requires detail and skill, and can be daunting for those unfamiliar with the process.  Our in-house credentialing expert is aware of the credentialing processes for numerous payors and is prepared to help clients credential as swiftly as possible to avoid any timely payment issues.  For those interested in reviewing their current billing company, how their practice is performing overall, or wanting specific reports (e.g. collection ratio, days in A/R, payor insurance mix), we also offer consulting services.
  • Online Payment PortalWe offer online payment solutions through our clearinghouse, Zirmed.  This payment portal has given some of our clients the ability to collect patient payments quickly and efficiently, while allowing our team to post payments as soon as they are received. This solution also allows patients to pay online during times at which our office is closed, something that both patients and clients love.

Our new site also highlights our current team.  We have included a “Meet the Staff” portion of this site because we believe it is important for our current and future clients to know who we are as people.  Sometimes it helps to put a name to a face and allows even more of a personal touch.  We encourage you to check out our “Meet the Staff” and get to know each of us a little better.

What You Need to Know About HIPAA Compliance

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, was developed with the goal of protecting sensitive and identifiable personal health information (PHI).  HIPAA (1996) is comprised of the Privacy Rule, the Security Rule, and Breach Notification Rule.  Under the Privacy Rule, entities, such as healthcare providers and medical billing companies, that work with personal health information are required by law to protect PHI.  The Privacy Rule also sets limits on how this PHI may be used (HIPAA, 1996).  With the advent of technology and electronic means for storing PHI came the Security Rule, which mandates standards for securing electronic personal health information (ePHI).  If a breach should occur, the law currently mandates that it be reported to the Secretary of Health and Human Services (HHS).

While HIPAA is complicated and continuously updated with the changing times, it is absolutely crucial for healthcare providers and their employees to be knowledgeable of the law.  Some ways to ensure that HIPAA compliance is being maintained in your office are:

  • Notice posting: HIPAA requires that notices be easily accessible to patients and that these are posted in office, are provided at the time of arrival, and are available on the provider’s website (Miller, 2017). Ensure that all members of your front office staff provide all patients with copies of HIPAA notices upon arriving to the office.  Display a HIPAA notice in a location in the office that is easily accessible and legible for patients.
  • Staff training: Regardless if staff are just starting out or long-time employees, it is essential that all staff members are knowledgeable and current on HIPAA compliance rules and regulations. Regular training would be optimal for office staff.
  • Assess/analyze: Perform yearly assessments or audits to determine if HIPAA compliance is being maintained in your office and if all ePHI is being handled in the appropriate and legal manner (Miller, 2017).

Today’s healthcare is continuously becoming electronically based, with the need for paper medical records going to the wayside.  With the Security Rule, providers are required to ensure protection of vulnerable ePHI.  This not only extends to the provider office, but also to any entity that deals with ePHI, such as clearinghouses, medical billing companies, and health plans.  There exists numerous electronic health records (EHR) systems that allow for better HIPAA compliance.  Our team highly recommends finding a HIPAA compliant EHR that works for your personal needs as a provider.

As a provider, you also need to partner with a medical billing company that values the importance of HIPAA.  At MedPro Services, all documents we transmit, maintain, and create with our clients are stored on a secure, off-site storage server.  In our office, all of our staff are educated and knowledgeable on current HIPAA practices and continuously strive to maintain compliance in our office.  When possible, we inform our providers of potential security breaches and areas of possible improvement to better preserve HIPAA compliance.  Our practice management system, Healthpac, is…..

HIPAA violations are no joke and no small matter.  Violators may be fined up to $1.5 million and may face up to 10 years in prison (AMA). To avoid consequences such as these, it is important to work with your staff and ensure that you are working with a medical billing company that values security and compliance.


American Medical Association (AMA) (n.d.) HIPAA violations & enforcement. American Medical Assocation. Retrieved from https://www.ama-assn.org/practice-management/hipaa-violations-enforcement

Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191

Miller, S. (2017, July). Troubleshoot HIPAA vulnerabilities with risk analysis and assessment. Healthcare Business Monthly, 44.


Importance of Patient Collections

Changes in the US healthcare system over the past decade have led to higher patient financial responsibility.  Per the Kaiser Family Foundation (2016), patient out-of-pocket expenses have increased substantially over the last decade, due to such things as high-deductible policies and greater cost-sharing expenses (e.g. co-pays, co-insurance).  As a billing company, it is our responsibility to inform our clients of the best possible means for collecting patient balances and to help maintain consistency in patient collections in our billing office and in the main office.

Cavanaugh (2017) provides some suggestions for increasing patient collections and maintaining up-to-date policies and education in the office.  I have considered these suggestions and added my own suggestions from personal experiences as well:

  • Staying Current on Payor Policies: It is critical for billing companies and office management to stay current on payor requirements for collecting patient balances. Most insurance companies put forth a set of requirements for collecting on patient deductibles, co-pays, and co-insurances.  Efforts must be made on patient balances before they are discounted or completely written off.  Failure to follow these requirements could mean a breach of contract, which could lead to contract termination and restrictions of contract-renewal.  MedPro Services’ staff strives to remain current on payor policies and we continuously inform our clients of these policies.
  • Patient Responsibility Policies: It is crucial for a practice to have a set and firm patient responsibility policy in place.  A patient responsibility policy may include how and when the patient will be billed, as well as expected payment timeframes.  A copy of the policy should be provided to each patient or is should be discussed verbally, but most importantly, it should be provided in a way that is accessible and understandable to every patient.  Make sure every staff member, at the front office and in the billing office, knows the patient responsibility policy.  This must be maintained consistently and with fairness for every patient.
  • Collecting Up-Front: Most insurance companies require that co-payments are collected at the time of service.  Prior to providing services, the office staff must check that insurance cards are current and collect the co-pay amount that is often listed on the front of the card.  If this amount is not listed, verify patient eligibility and co-pay requirements.  Taking these steps will ensure that accurate co-pays are collected at the time-of-service.  Communicate with office staff the importance of collecting payment up-front.  At MedPro Services, we communicate daily with the main office staff on patient balances, co-pays, and any credits that may result from overpayment.  Doing so allows patient balances to be collected up-front and in the correct amount.  If patients request greater clarification, our staff is always willing to discuss balance questions with the patient.
  • Documentation: It is simply good practice to maintain quality documentation in a medical practice and billing office. Anytime a patient calls or comes into the office, document the conversation to some extent in the patient’s account.  Document and keep record of all patient payments.  At MedPro Services, our personal policy is to maintain and keep substantial records of any patient communications and payments.  If ever for any reason a patient payment is not posted or there is a complication with a particular account, then our documentation will provide explanation and clarification in these instances.  We work best with clients who maintain good documentation in the main office as well.
  • Multiple Means of Collection: By providing multiples means of collections, providers are giving patients more opportunities to pay balances in full and on-time. Consider accepting a wide-range of credit card carriers (e.g. Visa, MasterCard, American Express).  MedPro Services offers our clients Zirmed Patient Payments through our clearinghouse, Zirmed, which allows patients to pay online, check balances online, and aids the office staff in balance collection.  In our modern society, streamlined and intuitive solutions such as these simply make sense when collecting patient balances.
  • Quick Payment Posting and Statement Cycles: Our billing company strives to post patient payments quickly upon receipt.  This helps to clear out balances and eliminates aging patient debts and the potential for duplicate payment.  We send statements out weekly and ensure that patient addresses are current to help avoid returned statements, and thus, unpaid balances.


Cavanaugh, M. (2017, May-June). Improve patient collections and stay compliant with payor requirements. The Journal of the Healthcare Business Management Association, 26-29.

Kaiser Family Foundation. (2016, September). 2016 Employer Health Benefits Survey. Retrieved from the Henry J. Kaiser Family Foundation website: http://www.kff.org/report-section/ehbs-2016-summary-of-findings/

Taking Control of A/R

One of the most important aspects of medical billing is accounts receivable (A/R), which essentially means charges still awaiting payment for services rendered.  Everyone on the medical billing team must know and understand what A/R means for the practice.  If A/R is neglected, then revenue is not received timely on aging claims, if at all, for the practice.  Maintaining A/R is not always simple, but it is necessary and doing so will generate the maximum amount of income for all employees in the practice.  The following are some essential points for taking control of A/R:

  • Establish an A/R Process. Wood (2017) suggests creating a spreadsheet or other form of record keeping to document A/R on a regular (e.g. monthly, weekly) basis. The spreadsheet should include days in A/R and balances remaining under those timeframes.  MedPro Services maintains A/R records in a location that is easily shared by all members of the team.  A document is created for each of our practices and is maintained continuously.  Each document indicates days in A/R and the amount due for each timeframe.  Without such rigorous record keeping, it is impossible to know what claims remain unpaid and how long they have been aging.  If your medical billing team or company is not performing this service and is not keeping rigorous, detailed records of A/R, then it is advisable to improve upon practices already in place, or to seek new and more advanced services, such as those offered by our team.
  • Team Communication. In her article, Wood (2017) also suggests finding ways to communicate A/R needs with the medical billing team.  She suggests continuous reporting of A/R efforts, comments on each line item to maintain work completed or to be completed, and harboring employee motivation.  MedPro staff would strongly agree with Wood’s suggestions.  We clearly notate on a shared, secure document the work completed or to be completed for each unpaid charge as well as clear and detailed documentation on each charge line in our billing software.  We hold monthly meetings in which each account’s A/R is reviewed and the A/R percentage for each practice is compared from the current to previous months.  Not only does this help with continuing on a trajectory of A/R success, but it helps motivate staff to see that their efforts are paying off or where further improvement and attention is needed.
  • Understand Payor Processes. For anyone who has worked in medical billing, it is common knowledge that some insurance companies pay slower than others.  This is often due to the process in which claims are paid within the company and specific payor guidelines.  Sometimes billing staff may be unaware of certain processes and guidelines put forth by specific insurance companies.  Per Woods (2017), it is important for all staff members to learn the processes for most if not all insurance companies.  MedPro works with clients all over the country and through experience we have come to understand the unique processes of various payors, which can differ greatly even depending on the state.  The healthcare field is complicated and although we are still learning about the guidelines and processes for each payor, we are confident in our ability to accelerate the reimbursement timeline for most payors and have set guidelines for knowing when reimbursement should have been received and when to act on aging claims.
  • Appeals and Collections. Finally, Woods (2017) reminds us of the importance of documenting and following up on appeals and also of maintaining patient collections.  Appeals processes can vary greatly depending on which insurance company the appeal is for.  Some companies and some states require specific forms.  Some require paper appeals, while others prefer electronic ones.  The appeals process can be frustrating, but following up on submitted appeals is critical.  At MedPro, we keep all appeals in a secure, sharable location where all team members may access appeal information at any time.  We follow-up on appeals in a timely manner to ensure receipt of the appeal as well as the status of an appeal.  If, for whatever reason, an appeal is said to have not been received by an insurance company, documenting appeals and keeping copies of appeals will make follow-up and resubmission all the easier.  Patient collections are also necessary to consider.  It is highly recommended that each practice has a collection agency on hand.  The collections process, however, must be maintained by your billing staff.  Keep records of all patient accounts sent to collections, which that are being held out of the collection process and why, and the status of collections paid.  All of this should be notated on a secure and shared document as well as on each patient account.


Wood, E. (2017, January). Quick tips for managing A/R. Healthcare Business Monthly, 42-43.

Small Billing Company vs Large Group

With the changing face of healthcare, many individually practicing physicians are making the move towards larger physician groups or hospitals.  While this move can have some advantages, it also can have some significant disadvantages to the individual provider.  If you are contemplating joining a larger group, consider first some of the following advantages of working with a small medical billing company:

  1. You Get What You Pay For. When it comes to medical billing, that old adage “You get what you pay for,” certainly rings true.  A large physician group or hospital may offer you a smaller percentage for medical billing costs; however, this usually means claims and payments are processed in large quantities, which leads to an increase in errors, poorer identification of claims issues (e.g. denials), and a lack of appropriate follow-up.
  2. A Personal Touch.   One of the biggest advantages of working with small medical billing companies, such as MedPro Services, is the personal touch.  Our data entry team and claims representatives are highly experienced and knowledgeable and truly have the client’s best interests at heart.  We get to know and understand the individual needs of our providers and get to know them on a personal level, doing site visits, having meetings, and communicating via phone and email on a regular basis.  You simply are not going to get this type of personalized service with a large group or hospital.
  3. Highly-Motivated Staff. The MedPro Services staff is highly-driven to get each claim paid, regardless of the dollar amount.  Working each claim to completion is what makes MedPro Services so special.  We will work tirelessly on claim denials and follow-up until we have exhausted all possible means of getting a claim paid.  We do this not only to maintain our integrity and honesty, but because if the provider is not making money, then neither are we.
  4. Clean Accounts. Working off the previous bullet, it is important to realize that one of the major goals of the MedPro Services team is to keep accounts in excellent standing.  We strive to maintain a high collection ratio for each of our clients.  We meet monthly as a team to see where each account is standing and work together to determine the best means for increasing or maintaining a good collection ratio.  Neglected accounts and aging claims are simply not an issue for MedPro Services’ clients.
  5. Knowledgeable Staff. All members of the MedPro team are knowledgeable on correct billing and coding guidelines.  We strive to obtain up-to-date information from CMS and other major insurance companies, so that we are continuously informed on the latest changes in the medical billing field.  Because our staff are all experts in the field, charges are entered correctly upon initial posting, which means fewer denials and less work on the back-end. This also means quicker turn-around time and faster revenue stream.

Collaborating with a Medical Billing Company

As was outlined in a previous post, transitioning to an outside, medical billing company can seem daunting and difficult, but following a few general guidelines can make this transition much simpler and more successful.  While the transition to a medical billing company is a crucial first step, true success happens when all parties are working together towards a common goal.  The goal of the Medpro team is to provide practitioners with the best medical billing services possible to optimize revenue and ensure success for our providers in an ever-growing and difficult healthcare system.  Our interests are your interests.  This is best accomplished through successful collaboration with the on-site, in-house staff.  Here are a few tips for cultivating successful collaboration with a medical billing company:

  1. Establish a Person of Contact. Choose someone within the main office building, who will be communicating most often with the medical billing company.  This person can be an office manager or someone hired to fill the position of billing company liaison.  Having a single point of contact will help the billing company know who to contact for needed information and to ask questions that may arise.
  2. Determine a Means for Communication. What is the best and quickest way to reach the person of contact?  What is the preferred method of communication?  Determine the most effect and HIPPA compliant means for communicating between the main office and the billing company.
  3. Develop a System for Sharing Documentation. How will the billing company receive demographics, charges, medical documentation, and/or payment information?  Is one method preferred over another?  In today’s modern era, the quickest, most cost-efficient means for transferring data from a provider’s office to a billing company is through electronic means, such as online documentation storage and electronic payment portals.  If your office is not currently equipped to handle efficient, electronic data sharing, then consider doing so as a means for cutting down costs and improving efficiency.
  4. Share Documentation in a Timely Manner. As mentioned in a previous post, determine a turn-around time for posting demographics, charges, and payments.  Once this turn-around time is understood by both parties, then charge and payment processing can begin.  While it is the responsibility of the medical billing company to post charges and payments in a timely manner, it is also the responsibility of the office staff to provide this information quickly.  The quicker this information is provided, the quicker revenue will stream into the practice.
  5. Return Needed Information in a Timely Manner. It is possible and likely that information will be missed when it is shared from the main office to the billing office.  Sometimes demographics are missing key information, charges are missing diagnoses or procedure codes, or a medical report is needed for billing out surgical charges.  Whatever the reason, once the information needed is communicated by the billing office to the main office staff, the retrieval and return of this information needs to be expedient.  Establish a timeframe for returning requested/needed information to the billing company.  If the billing company is requesting information, then they cannot process charges in a timely manner.  This all boils down to revenue and how quickly it will flow back into the practice.

Transitioning Successfully to a Medical Billing Company

Sometimes the solution to optimal revenue flow and a streamlined practice is in hiring an outside billing company.  Hiring an outside billing company can seem intimidating and stressful, but the process certainly does not have to be.  Here are a few key strategies to ensuring a successful transition to a new billing company:

  1. Clear Communication. Before a transition even begins, provide clear communication on what your goals for your practice are and how the billing company can help you to achieve those goals.  Open lines of communication will help the billing company to know what you would like from them and what the company can expect from you.
  2. Transition Time. Transitioning from in-house billing to an outside billing company takes time, patience, and preparedness.  Realize that some insurance companies, such as Medicare and Medicaid, will require re-credentialing to establish the new billing location.  Allow ample time for this.  It is possible that slight, initial changes in revenue flow will occur, but that these will ease and improve with a successful transition to a new billing company.  Allow the new billing company time to become acquainted your in-house staff and how your practice is run.  The more familiar the billing company is with day-to-day operations, the better service the company can provide for you.
  3. Establish Workflow. Since the billing company will not be in-house, providing a means for effective two-way communication is essential.  How will data be transferred?  Is document sharing optimized for efficiency?  Who will be the appointed in-house representative of communication between the office and the billing company?  How will this communication occur?  Determine immediately how such things as demographics, charges, and payments will be transferred from the practice to the billing company.  Utilizing web-based programs can provide the most efficient workflow, but this may not be optimal for all practices.
  4. Provide Access to Information. The medical billing company is working with you to optimize revenue.  To do so, the billing company must have access to data, such as medical reports, charges, and patient demographics.  Provide the billing company with ample access to online-payment services, such as Emdeon or Payspan.  Also allow the company access to insurance websites for information on claim status, eligibility, and remittance advice.  All of these things will help when working follow-up and denials and ensuring that essential time and revenue is not lost.
  5. Turn-Around Time. Establish with the billing company a desired turnaround time on data entry, claim submission, and payment posting.  Turnaround time not only depends on the efficacy and experience of the billing company, but also on the efficacy and organization of in-house staff.  Identify when and how office staff will provide demographics, charges, and payments and communication this with the billing company.  The faster information is received by the office staff, the faster it will be processed by the billing company and, thus, revenue will stream into the practice at a quicker rate.

The choice to work with an outside medical billing company is not an easy one and one that takes great trust in the company you have chosen.  Working collaboratively with a knowledgeable and experienced medical billing company, such as Medpro Services, will make the transition far less daunting.