Our Pick
Based in the U.S., Fortis Medical Billing takes care of billing and coding for hospitals and other medical establishments. The company aims to reduce rejection, denials, and unpaid claims. This way, revenue can improve as high accountability techniques are utilized. Fortis is often used by healthcare establishments that do not have the staff to spare for the billing department, allowing them to put all of their resources into taking care of the patients.
Pros
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Hospitals have shown a higher claims collection rate, which ultimately led to an increase in revenue.
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Reduced practice stress, as billing will no longer be an extra issue to handle.
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Billing audits become available when you feel like your success rate is not what it should be.
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Allows you to remain fully compliant, as you have professional staff working to ensure that every regulation is respected.
Cons
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The implementation may be slow, as the billing company will take the necessary effort to make customized plans.
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Hospital staff will receive an action plan, but they will have to do the implementation themselves.
Hospital service has become more and more demanding these days, with patients constantly making claims and payments. With the influx of people coming and going, you will need someone to handle your billing needs. You can either put aside members of your staff to do this – or to save manpower, you can outsource it instead.
That being said, there are plenty of hospital billing services out there – and this can make their selection rather confusing. But as long as you know exactly where to look, the choice should be much simpler. Here are some key factors to look into when selecting the best company to outsource your billing.
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Billing Prices and Fees
One of the most obvious keys to hiring a billing company for your hospital is how you will be charged. First of all, there is the budget. If you plan on hiring the firm for a longer-term, you must ensure that their prices are within the revenue that you get every month.
You might be tempted to go for the cheapest companies to save some money, but that is not necessarily a good thing. The cheaper the billing company, the more services will be excluded from your billing package. Since you are paying anyway, you need to make sure the services offered will cover the practices that you want to outsource.
Secondly, take a look at the pricing model; how exactly are they planning to charge you? For instance, some companies prefer taking a flat fee every month or per claim. This fee will not change, regardless of how high your net collection is. This is a good option for hospitals with a steady cash flow.
Other hospital billing companies prefer charging a percentage of your total collections. In case your collections do not go past a certain amount, you will be charged a floor rate. This is a good option for a hospital that does not have a daily steady flow of patients and gets different revenues every day.
Talk with the billing company and see exactly how they plan on charging you. Even if the fee is higher, you should at least ensure the service package you get is worth the price – which brings us to our next key factor.
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Service Inclusion
No two services are made equal, and this applies to hospital billing and coding services as well. Each company usually caters to a different specialty, or even focuses on providing a specific service. This is why you have to create a list of the services that you need and cross-reference them with the services that they offer.
For the most part, here is what a billing company for hospitals usually helps with:
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Overpayments and Refunds
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Patient Statement
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Analytics and Reporting
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Follow-Up on Accounts Receivable
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Credentialing
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Claim Submission
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Review for Medical Coding
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Insurance Eligibility
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Payment Posting
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Denial Management
Different companies will offer different services, but you should start with what your needs are. For instance, if your problem is with denial management, then you may want to go for a billing company that prefers to help with this particular service.
Make sure that the services provided are covered by personnel with experience in those areas. Check with different online reviews and see what their strong points are. What issues have they helped people with the most? Compare them with other services and see how you can benefit from what they have to offer.
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Training Potential
Training is still a fairly new feature for billing companies, and it may not be a potential red flag if you do not see it. However, it will be beneficial for your company in the long term. This is especially the case if you had long-term issues with your revenue cycle results.
Many hospitals have no problems with billing knowledge; the main issue is that they simply do not have enough staff to spare for billing the patients. This is often the case with private practices and small hospitals that have only begun operating.
With that in mind, there are also practices where the billing staff is simply not prepared enough. The revenue flow is affected because they do not know how to explain insurance properly and how to ask for payments.
Training could help with your revenue increase in the longer term, especially if you are only planning to outsource to the billing company in the short term. Your staff will learn how to reduce payment delays and errors, improving your payment demographics.
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Denial, Rejection, and Unpaid Claims Rate
When it comes to medical billing, one needs to know how to handle denials. This is a great challenge for healthcare, and whether we like it or not, it continues to happen at all times. That being said, denied, unpaid, and rejected claims can cost a practice up to $100,000, something that can prove quite catastrophic for your finances.
Make sure to ask the right questions, such as:
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What is their average rate for denials?
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How are the claim errors identified and corrected?
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What solutions do they use in order to approach denial management?
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What steps does the hospital billing company take in order to prevent rejections and denials?
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What report types are given in order to showcase the denial management process’s effectiveness?
These issues are very important to keep note of, as they can save you a lot of money in the long run. It is important to go for a company that is open even about their rejected claims. Most services will be reluctant to provide this kind of data, but if they do, then there is a very good chance that they are truthful about their other rates as well.
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Data Security
As a hospital, you will become privy to a lot of personal data from your patients – data that you must protect. This is why your billing company of choice must have Protected Health Information (PHI) . If they do not claim to have PHI or HIPAA regulations , then you may see that as a red flag.
Talk with the billing company about password storage, encryption policies, and how they handle and destroy PHI coming into their system. A reliable company should have a well-placed privacy and data collection policy in check. If they cannot promise to offer high-security levels, then you might want to start looking elsewhere.
The Bottom Line
You should do as much research as possible on the hospital medical billing company that you want to work with. They will take care of your finances and cash flow. So, the right choice may lead to a higher claim collection, along with higher revenue. Compare and choose wisely based on the factors above.
