In 2015, providers are faced with numerous Health IT challenges, significantly more than ever before. Meeting Meaningful Use Stage 2, reporting in line with PQRS standards, and getting ready for the switch to ICD-10 would make the top of every providers list. With all of this already on your agenda, the hassle of optimally managing your medical billing as well isn’t short of impossible.

Go for outsourcing

A competent and capable medical billing company for your practice can help transform the operations of your practice. First things first, 2015 is the year of outsourcing. Don’t go for an in-house team, as you’ll soon agree that they cost a lot more than an outsourcing company.

Here are the additional costs associated with an in-house team: staff salaries will exceed billing service charges (explained later on), you’ll need dedicated systems (including costly software and hardware) for these billers, dedicated office space and furniture for the department, and incur numerous miscellaneous costs.

Other benefits of outsourcing are explained under subsequent headings.

The target

Before doing anything else, make a list of what all you expect the billing company to handle. Is it only the electronic claim submission process, or do you expect them to handle payment posting, follow-up, validation, eligibility verification, and other related tasks.

Most practices in 2015, however, would expect their billing vendor to handle the entire process; this would normally begin with insurance verification and patient demographic entry, cover procedural processes such as coding, entering charges and posting payments, and end with following-up on receivables, managing denials and reporting.

Privacy and security mechanisms

This is a feature that will be extremely important in 2015, and one you must not compromise on. Your comparison of billing vendors must give a lot of emphasis on information privacy and security.

This is because even if the patient information is safe on your end, any leakages on the end of an under-prepared billing company could result in huge monetary and reputational damages to your practice.

Select the billing vendor who possesses a secure facility, ensures that they are following HIPAA compliance regulations, has the latest security checks in place, and possesses backup and emergency plans.

Keeping you posted

You must also ensure if the potential billing company you’re considering can provide you with reports whenever you require, and for any process you require; for example, if you’re unsure of the status of some claims sent out a week ago, they should readily answer your queries upon inquiry.

They must be able to readily (or periodically in some cases) provide operational, denial-related, and data analysis reports when you require them (or as soon as there is enough data to compile a report). If they are unable to “keep you in the loop” at all times, they might not by very reliable and efficient.

The cost

Most of the top billing companies will charge a small percentage of your monthly collections for their services. The one that charges the lowest percentage might not be the best, so you must choose from firms offering competitive rates, and compare that with their market reputation before making the decision.

ICD-10 readiness and support structure

October 1, 2015 is the date from which all your claims will be billed on ICD-10 codes. This means that not only must your billing company be equipped and ready for these changes, but they should also offer a detailed plan for ensuring that your practice is too. They should provide you an estimated time line for ICD-10 testing, and offer in-depth consultancy to help you get ready for ICD-10 before time.

Clearinghouse linkages

A billing company of 2015 should ideally have its own clearinghouse. This will speed up the whole billing process for all parties involved — insurance, billers, providers, patients — benefiting you the most as you’ll get paid markedly quicker.

You could also opt for a medical billing vendor that does not have his own clearinghouse, provided that the vendor uses the services of top clearinghouses, and doesn’t charge you extra for these clearinghouse services.


The vendor you are considering must also have a staff base that can easily handle all its clients so do inquire about the professionals they have employed, and how do they manage their clients. Moreover, you should look for a vendor that is offering a dedicated account manager for your practice; an individual you can approach for billing-inquires whenever required.

Additionally, you must also give consideration to referrals as they will help you assess how others are rating the billing company you are thinking of selecting. After taking all these factors into consideration, you will avoid all loopholes that would otherwise result in the selection of any billing company for your practice; leaving you with just the best options to choose from.