What Type of Medical Billing Company Do You Need?

By Aimee Heckman  |  August 7, 2018

Think it's time to start looking for some outside billing support? (Not sure? Take this assessment: Is Outsourcing Your Medical Billing the Right Choice?) Not all billing companies are alike. Services can vary greatly. Finding the right RCM partner will depend on knowing what services you need. Most billing companies fall into one of three categories: light, full-service or boutique. Making sure you know what level of service you need is critical to picking the right partner.

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RCM Service Levels

Light

Level of service offered by many billing software vendors.

  • Practice is responsible for all coding validation and working rejections due to patient demographics issues, eligibility, authorizations, etc.
  • Light RCM services require that there is someone in the practice familiar with the front end of the billing process and capable of getting claims out the door and accepted by the payer.

Full-Service

Level of service offered by some software vendors and most traditional billing services.

  • Full-service billing companies engage with practices at an earlier stage in the revenue cycle, providing the technology tools and training to verify eligibility, demographics and insurance card information during the check-in process.
  • Billing company communicates with practices on how to manage rejections and  provides feedback on how to avoid rejection-causing mistakes in the future.
  • Does not require the practice to have skilled billing staff to work rejected claims themselves.

Boutique

Level of service typically offered by smaller “mom and pop” billing companies who have expertise in a limited number of specialties and/or provide more oversight.

  • Billing companies at this level go far beyond simple claims submission, payment posting, and follow-up of accounts receivables.
  • This higher-fee level of service suits providers who want the billing company to handle all business aspects of running their practice.

For practices that are unable to find the right in-house billing staff, a full-service or “boutique” billing company can allow them to remain independent and still maintain the KPIs needed in today’s complex billing environment. Billing companies vary in the services offered and it’s important to have responsibilities clearly defined in any contracts executed.

For a comprehensive guide to assessing the financial and operational ROI of partnering with a billing company, download the resource below.

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