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medical claims billing

Need to Hire A Medical Biller?

     When you find that you need to hire a medical biller to take care of your in-house billing, there is much to consider. It can be very difficult to find a person with your needs.

     Make a list of the things that are important to you in the person you are trusting to do your insurance and patient billing. Some of the things you might want to consider are:

Honesty -

     When you hire a medical biller, she must be honest. She will be in charge of your money - cash and checks and possibly credit cards. You want to be sure that all the money you’ve worked for reaches your checking account so you are able to cover your expenses and make a profit.

Beyond the cash that is coming into your office, you want to be sure that your medical biller is not hiding or ignoring denied claims. This can be one of the biggest problems in your office in keeping your cash flow flowing. It is very easy to overlook and can be HUGE!!

     We found an office once where the pregnant office manager who was also the medical biller, had left and we were called in to take over while she was out. What we found was beyond belief - Tens of thousands of dollars worth of unpaid insurance claims hidden in a cupboard - claims that may have been denied incorrectly or never sent.

   The office manager was overwhelmed with her job and just didn’t have time to take care of these problems. That’s tens of thousands of dollars in lost income. So the doctor may have saved a couple dollars an hour and got a bargain office manager, or he may have hired his niece as a favor to his sister, but he lost a lot of money because he trusted someone he shouldn’t have.

Experience -

     Unless you have a lot of time to train a person to handle credentialing, coding , submit insurance claims, track these claims, submit secondaries, resubmit when not on file and appeal your insurance claims, make sure you find a person who has the experience you need to make sure you get paid.

     It is extremely important that when you hire a medical biller that they understand insurance billing completely. They need to be able to read eob’s (explanation of benefits) and know how to properly respond to them. Eob’s can be very complicated to read and interpret correctly. Your income hinges on this knowledge.

     They need to know how to contact insurance companies and who to speak to when they call. They need to know how to get around the automated voice systems used by insurance companies to get to the answer they are looking for.

   They need to know your practice management system well enough to use it effectively. This may take a little time to completely learn a new practice management system, so you want to be sure they are a fairly quick learner.

  The person you hire needs to be thorough. We once found an office that never posted the insurance payments. So what? Well, that means first of all that no secondary insurance claims are being filed except the few that are forwarded automatically and no patient payments are being billed.

    Also, there was absolutely no way to make sure the insurance companies had paid the claims that were submitted. I can’t tell you how many times we are told “not on file” when we are working our aging reports. So, none of their “not on file” insurance claims were ever paid. Again, thousands of dollars that were due to the doctor were lost. Your billing person needs to go after insurance payments as if it were her own money she is collecting.

Understanding -

     Your billing person needs to understand insurance and patient billing inside and out. They need to understand the computer, your practice management system, electronic verses paper billing, which forms to submit to which insurance companies, how to check to see if everything is getting paid, what to do if something doesn’t get paid, how to tell what a patient owes, and when to send patient statements. And this is just a start. If they lack in the understanding of any of these duties, it will cost you money.

    It makes much more sense to pay someone very well that will maximize your receivables than to choose someone less qualified because they are willing to work for less money and consequently bring you in less money.

     Never base your decision on hiring a person to handle your insurance billing on the wage they are willing to work for. You'll loose out in the long run.

Systems -

When you hire a medical biller, she needs to be capable of setting up and using good systems for accomplishing her work. Good systems keep fires from growing. Falling a little behind on your insurance or patient billing will quickly cost you money. Systems need to be in place to keep things from getting out of control.

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