RCM issues to Consider While Selecting a Medical Billing Company

Are you facing difficulties finding a medical billing company to look after the financial health of your business?

 Everyone in the healthcare industry knows that reimbursement laws are constantly changing, and this change will continue. The reimbursement laws are changing from per visit to the quality of service provided.

A professional medical billing services provider must have recent know-how of the industry changes. One of the most vital features of the medical billing firm is to train their staff about the latest laws and regulations. At the same time, when searching for the best medical billing companies, you must check that they do not have a complicated process. The simpler the process a billing company follows, makes it easy for your existing staff to understand. Thirdly, a medical billing company must guarantee a rise in collection rate and a reduction in denials.

Outsourcing medical billing can increase your company’s profitability and reduce staffing and other overhead costs. Before selecting a medical billing company, you must ask the following questions from them.

Is Medical Billing Company providing weekly, monthly or quarterly reports of current A/R?

Set your target of the lowest accounts receivables. You must start to measure accounts receivables in days

A simple formula for measuring AR in days =Total AR/ Average daily charges.

The cash inflow of your business declines if the AR days increase. It would help if you had cash inflow to pay better staff, physician or para-medical staff etc. The increase in AR days has a negative impact on your business.

You can group you’re A/R days under the following classifications

Zero to thirty days

Thirty-one to sixty days

Sixty-one to ninety days

Ninety-one to one twenty days

Over one twenty days

If your Account receivable days are more than one hundred days, it means some of the Account receivables will be in bad debts, or you have to wave off the amount. The medical billing company is responsible for keeping the A/R days less and maintaining a regular cash inflow to your business.

Is the medical billing company offering denial management for previous or existing claims “Denial Management?

Different hospitals, healthcare practitioners and clinicians use manual EHR support methods for claims denial. A revenue management cycle is a continuous process of claims management. Ask your medical billing company about the denial management for the previous and ongoing claims. Ask about their platform or software that is in use. To speed up your process, the medical billing company must use AI-enabled devices and tools for denial management. You can ask for the demo before selecting the specific medical billing company.

Are they able to track and analyze the “Rejected Claims”?

The research found that around 20-30% of claims are rejected, and of these rejected claims, 80% of them remain unprocessed. If your practice is among the ones that leave the rejected claims unprocessed means, you incur a thousand dollar loss annually. Can you afford this loss? The answer is no. Every business entity wants profits to reinvest in expanding their businesses. So, it is also important to take care of the rejected claims.

An efficient medical billing company will also offer to track, analyze and try to clear your denied claims.

Can a medical billing company offer “Code Analysis?”

The report includes top used codes, top paying codes and most denied codes. Code analysis is important for your revenue management cycle. A medical billing company that can provide code analysis will be able to provide you with alternative solutions. A medical billing company can provide code analysis only if they train their coder and biller regularly. And their billers have hands-on knowledge of recent coding.

What do they know about “Contract Analysis”?

Every state owns its insurance coverage plans. Some States offer comprehensive healthcare plans, whereas others may cover only minimum requirements set by the federal government. A medical billing company with up-to-date contract analysis information can help you maintain a healthy revenue management cycle.

Do they know “Fee Scheduling?”

A medical billing company can add value to your business if they have “fee scheduling” knowledge. Medicare updates fee schedules once a year. The change in fee schedules affects your reimbursements. Your business needs to choose a medical billing company with knowledge of Fee scheduling and Medicare updates.

Are there coders certified?

Most of the claims rejections are due to wrong coding, under coding or up coding. A mistake in coding affects your revenue management cycle. So, before outsourcing a medical billing company, it is important to ensure that certified coders take care of your coding requirements.

Are there coders “Specialty specific”?

If outsourcing a medical billing company can increase your profitability, professional-specific speciality coders can boost your productivity to even higher levels. So a company with speciality-specific coders will add more value to your company.

Are there billers “EMR Specific”

Why asking about EMR-specific billers is important? An EMR-specific biller can understand the present systems of a medical facility is using.

Most healthcare facilities face problems with their in-house billing team as they are not complying with the EMR/EHR of the healthcare. A medical billing company that offers EMR-specific billers can affect KPI performance positively.

Is it reasonable for them to provide “Patient Eligibility Verification” services?

Patient eligibility verification is important for uninterrupted revenue cycle management. It is a mandatory process when a new patient visits your facility. A medical billing company that provides “Patient eligibility verification” can benefit in the minimization of patient payment problems. Patient eligibility verification is helpful, especially if the patient is unaware of the insurance coverage. When state laws alert, the change can also alert the insurance coverage. So, it is also an important criterion to check patient eligibility verification to avoid unexpected losses.

Do they have multiple teams’ specialized sections?

The reimbursement of a medical facility depends on claims clearance, clearance of rejected or denials. A medical billing company specializing in individual teams handles multiple sections of the revenue cycle. The individual team for the specific section of medical billing will quicken the revenue cycle management process.


How much transparency a medical billing company offers? It is vital to counter-check your reports. Select a medical billing company that provides you with periodic reports. A medical billing company offering multiple reports will help you maximize your financial growth.

Do they offer collection techniques?

A medical billing that can offer patient correspondence with the patient can help you streamline your bills and optimizes your revenue collections. A medical billing company that initiates telephone calls, letters, emails, chats etc., will help your patients to remind and pay their bills.

Do they offer an “Insurance specific calling team?”

Check that the medical billing company has insurance specific calling team? If a medical company owns a separate team for insurance calls means they are specialized and know the difference between denials and rejections. They can do better follow-ups and increase your profitability.

Is medical billing company “HIPAA Compliant?”

HIPAA compliance is a vital feature for the medical billing company. The Healthcare industry deals with a lot of personal and health information, and healthcare facilities cannot put this information at risk. So before adopting a medical billing service provider, it is important to check whether they are HIPAA Compliant or not.

Are they providing “credentialing” services?

Credentialing is a vital documentation process for medical professionals in an insurance company. A medical billing company that offers credentialing services will help you in all sections of your business.

A healthcare provider must ask the questions before adopting a medical billing company. A medical billing company that is the one-stop solution for your business can help you in bringing financial success.

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