5 Things to Look for in a Medical Billing Provider

Find the Right Medical Biller 

Many medical practices are now outsourcing medical billing. Why? Short answer: they get you the most bang for your buck. Their primary job is to maximize revenue for your medical practice. Think of them as your lawyer: they go to bat for you against the insurance companies, fighting for every penny they can get you per claim. They are experts at medical coding and know how to best use the system in your favor.

stethoscope on computer

While there are definitely perks to having a loyal in-house medical billing staff, it’s unlikely that your staff has the same amount of time, knowledge and incentive that is required to successfully negotiate claims, not to mention staying up to date on insurance and coding policies.

Here are 5 things to look for when shopping for a medical billing provider:

1. Security

It is important to know how the company will handle the security of all your patient files. It’s surprisingly easy to violate HIPAA standards (whether intentional or accidental). If HIPAA standards are violated, your practice could be liable and therefore, penalized with some hefty fees. Ask the following questions:

  • Who will be handling the patient data?
  • What type of access will they have?
  • What kind of security measures will they put in place to ensure patient privacy?

2. Fee Structure

The average fee for a medical billing service ranges between 4% and 16%. Factors that determine total cost include the size of your practice, the number of claims you submit, and the monetary value of those claims. For example, if you have a smaller practice that submits only a few claims per month, but most of them have a high monetary value, you will pay a lower rate than a larger practice that submits thousands of claims per month at a low monetary value.

It is important to ask a medical billing service about their fee structure because not all companies do it the same way. The most common fee structures include:

  • Amount Collected – based on a percentage of all claims that have been collected (excluding deductibles, co-payments, and other in-office payments)
  • Total Claims Submitted – based on a percentage of all gross claims to any insurance provider or other debtor
  • Total Collections Processed – based on a percentage of net collections, including deductibles, co-pays, and any other payment.

Be sure to ask questions to be sure to avoid the sneaky fee structures.


One stop shop

3. One Stop Shop

Some medical billing companies offer all-in-one service. Not only are they responsible for the medical billing within your practice, but they also manage your IT and billing software training. The pros of this model: it keeps things simple and streamlined. Cons: more expensive and greater security risk. But if you do your research, you can find a reputable one-stop shop. It’s just a matter of cost and preference.

4. Specialty

Just because a medical billing service is strong in one area of healthcare does not mean they are experts in all areas. As both the healthcare and insurance industries become increasingly more complex, many medical billing providers are choosing to specialize in one area of healthcare. For example, there are now medical billers in mental health, neurosurgery, pediatrics, ENT, etc. You want to find a medical billing provider who is knowledgeable in your area of healthcare so that they can successfully negotiate on your behalf.

5. Customer Service

You know the atmosphere of your practice. When considering a medical billing provider, you want to find someone that will be a good fit with the patients you serve. When shopping for a service, pay attention to the level of customer service they provide, either by phone or online. Put yourself in your patient’s shoes and ask: is this a good experience? You want to keep your patients happy and help them feel comfortable when dealing with benefits, claims, and other complex issues.

Some helpful questions to ask:

  • Number of years of industry experience
  • Average collection rate
  • Average processing rate
  • Quality of specialists
  • Ease of software
  • Level of support and follow-through

Learn More

Find comprehensive information on medical billing in our Medical Billing Buyer’s Guide.

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