Compare Medical Billing Service Prices - BUYERS GUIDE 2017
What are Medical Billing Services and How Much Does it Cost?
Before and after a patient receives treatment, healthcare providers must submit and follow up on insurance claims with the patient’s health insurance company. Medical billing software, a growing part of the healthcare industry's automated connectivity, digitizes this process and reduces the cost and time associated with handling phone- and paper-based claims.
Medical billing services can cost from $900 to over $11,000 depending on enterprise size and whether or not you want on-site servers. Web-based or "cloud" software runs on off-site servers and can cost as little as $25 to $100 per month. Many vendors also charge a percentage of claims processed using their software. Other factors include the number physicians using to software and how many patients seen per day.
Compare Medical Billing Fees and Pricing
A medical billing service can be a huge help. But do you know what they cost? Keep reading for everything you need to know to make an informed decision.
Outsourcing to a medical billing service or handling billing in-house is a question many providers must answer. The cost of a billing service may be less than in-house but what services are included?
Will customer service suffer?
Will collections increase?
Will the service help identify problem areas in the practice?
What follows is a helpful guide to medical billing services and what they cost.
What a Medical Billing Service Does
A medical billing service provides complete billing cycle management. This starts with a process called patient enrollment. It consists of patient registration, confirmation of insurance eligibility and verification of coverage.
Next, the procedures performed are coded, the claim is prepared, then submitted for payment. Follow up with the payer is next to confirm receipt and make sure payment is timely.
The service also takes billing phone calls from insurance companies and patients. The service receives payment, checks it against the billing and deposits it into the provider's account. Sometimes they withdraw fees first by using a separate account.
When a claim is not paid timely, or denied, the billing service pursues the payer for a set amount of time. They file and track appeals to insurance companies while following up aggressively.
Billing services provide comprehensive reporting at set intervals. Customization is available to include other data, as well. These reports include
- charges billed
- revenue collected
- accounts receivable
- patient responsibility
- denied claims
They may also participate in audits for coding, timeliness, or HIPAA compliance.
Most services can tailor their offerings to the provider's needs. This may include patient scheduling and reminders or practice management consulting. But how are services compensated for their work?
How a Medical Billing Service is Paid
There are three main ways billing services charge their clients. Others may exist too, but these are most common.
The first way is by receiving a percentage of the provider's collections. This can be done three different ways.
The first is to charge the provider a percentage of the net receipts it helped collect. Accountability is built into the agreement because the billing service only gets paid when the provider gets paid.
The second is to charge a percentage of the gross claims submitted. This can result in a favorable percentage but the incentive to aggressively collect on submitted claims is removed.
The third is to charge a percentage of the total practice collections. A big advantage to this method is the provider, or practice, no longer handles the collection of co-pays, deductibles and denied claims from patients. This method is used often used in comprehensive practice managementagreements.
Fee per Claim
In this method, the billing service charges a fixed rate for each claim. The provider pays the same amount for processing of a $70 claim or a $700 claim.
Here's an important thing to remember. The lower the fee, the less follow up is likely by the billing company. Higher per claim fees often mean the service does more follow-up. However, fee per claim pricing lacks the incentive to collect that percentage pricing does.
The third way clients are charged is a hybrid of fee per claim and percentage. Submissions to some insurance carriers are handled for a flat fee while others are charged at a percentage.
This type of arrangement arose out of a couple different circumstances. Some insurance carriers started objecting to percentage agreements. To keep their clients from being dropped by a carrier, billing services offered the flat fee instead.
The other circumstance is legal in nature. Some states, like New York, outlawed percentage agreements on Medicaid claims. This was done over concerns with up-coding, to higher priced services.
Services provided and how they're billed are out of the way. Now it's time for some tips on how to choose the best medical billing service.
Choosing the Best Medical Billing Service
Billing services save providers and practices money, time and headaches but they're not all the same. Below are three things to keep in mind when choosing the best medical billing service.
For practices of a certain size, billing services usually offer a standard package. Eligibility is determined by minimum claims submitted weekly and the amount collected per claim.
For example, a practice submitting 100 claims per week at $75 per claim is eligible for a full-service offering at a preferred percentage.
For smaller providers or those with specialized needs, individual billing is available. The billing service and provider set the percentage and list of services provided.
Customization is key. The best billing services work with providers to meet their needs, regardless of size.
The percentages billing services charge may vary due to a number of factors.
One is the provider's specialty. Providers, like family practitioners, who have lower per visit billing may be charged a higher percentage. In turn, a provider who sees fewer patients at a higher cost per visit may be charged a lower percentage.
Another factor in determining percentages is geographic location. In some areas of the country, certain procedures are more common. In others, certain procedures are more expensive.
A third factor is the services offered. A comprehensive list of services demands a higher percentage than basic billing and claim submission.
Compare Service Offerings Of Medical Billing Companies
Not every billing service charging 5% of collections is the same.
Each offers a list of services but some are more comprehensive than others.
Before making a decision, compare their service offerings to find the best value. Some services to pay special attention to are...
- Hours of Operation - 24/7 service is the gold standard
- Speed of Insurance Transmission - faster submission equals faster payment
- Reimbursement Velocity - there's a difference between 25 and 40 days
- EMR Software Integration - EMR's are the future of patient information
- Provider Credentialing - grow the practice by increasing in-network carriers
A medical billing service not only takes hassles away. It helps providers and practices grow. It does this by increasing collections, reducing the billing lifecycle and building a larger network of carriers.
Visit our Buyers Guide to compare medical billing service prices in your area.
Medical Billing Service Sample Costs
Below are a few examples of price facts for Medical Billing Services which will give you an idea how how much you will pay for you purchase.
- 8% average cost by percentage of collected medical debt.
- Medeye services range between 2% to 4% on average.
- Most set up fees are free but a few can cost as much as $250 to $1,000.
- Emperia Medical Billing is generally 4% of all collected revenue.