When a medical practice takes the step towards outsourcing their medical billing service, the key priority is to choose a reputable company that they can trust. A physician have to ensure that they engage a company that will be able to reduce the headaches around billing issues

while at the same time protecting and securing their patient’s private data.

A great choice will allow the physician to spend more time on his patient’s care.

So, how do you go about evaluating medical billing services?

The right billing service should:

  • Be established with verifiable industry experience. They must have experience as a medical billing service.
  • Protects patient privacy by being compliant with the Health Insurance Accountability and Portability Act.
  • Have staff members that have been certified by the American Medical Billing Association. This means they have in-depth knowledge of medical technology, CPT4, ICD-10 and HCPCS Coding as well as HIPAA.
  • Make use of the latest technology
  • Have a high level of service excellence. In the service level agreement make sure you are clear on whether the service will follow up on denied claims and unpaid bills.
  • Provide multiple support channels including email, phone, live, messaging, etc. along with in-person training or webinars to assist the provider’s staff on how to use their medical billing features and how to improve the practice’s revenue cycle.
  • Use a competitive pricing model
  • Not have too many clients on their books. They must have the capacity to execute the demands of your billing cycle timeously.
  • Share data on how to improve the practice. They will have reporting  tools which could be exceptionally helpful to the medical provider. Be sure they are open to sharing their insights.


The functions you will need from an experienced medical billing service provider include claim generation; insurance carrier follow-up; payment adjudication; patient invoicing; patient support. These are the core elements of an efficient medical billing services company. The provider should be efficient in pursuing denied claims. Following up with insurance carriers should be one of their fundamental strengths.

Many medical billing service providers offer a range of other features including appointment scheduling, insurance verification,  medical coding. The more services are chosen, the higher the fees. The choice of medical services must be based on the cost as well as what the physician can realistically execute and what  needs to be outsourced. There are three price structure possibilities – percentage-based, fee-based and hybrid (a combination of percentage-based and fee-based).

Once a provider chooses a medical billing service, the next step is to measure their performance. After about three months on the job, go back and do a charge capture audit on their work. Compare the data of your registered patients, and see if all procedures have been accounted during this time. Doing a spot check is vital to reduce revenue leaking.

Another area to evaluate is the billing services coding accuracy. Is the company using an autocoder?  How often do they audit their coders? Are all of the physicians using the appropriate codes to ensure maximum reimbursement? The billing company should be revealing a 95% accuracy rate.

It is important to know how your medical billing service monitors underpayment

To make sure a provider is being properly reimbursed, they need to be privy to the contracts that have been negotiated. The billing company should be delivering at least 85% of the collections every month. It is essential to know how the vendor manages denials and what process they employ to report them to the provider. The reports the vendor submits should detail denial trends. Once these denial reasons have been analyzed, they should furnish a plan on how to reduce them.

The medical billing service does all of the heavy liftings and can free up time that could be better spent on seeing more patients in a day.