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Looking to Outsource? 8 Things to Consider with a Medical Billing Partner

Updated: Nov 14, 2021

Quality matters, not quantity. Having a bigger healthcare claims management team will not bring about better results. Rather, it would be better to have an efficient team that knows what the errors are and where your attention should be given.

It’s important to have someone or work with an outsourced solution that specializes in medical billing claims, and able to provide full-cycle medical billing services. Below are some important factors helpful in reducing billing claim denials.

1. Quantify and Categorize Medical Claims

Find a team that excels in quantifying and categorizing data. These practices invest ample time and effort in collecting, researching, and analyzing trends reported by doctors, departments, and payers. Utilizing advanced technology and analytical programs is a necessary part of the business model.

2. Mobilize Your Personnel

Experienced and proficient personnel can recognize and collect denial trends. They understand what needs to be the next step in terms of resources and solutions while tracking the progress of the client's claims.

3. Enhance Quality Of Patient Data

Improved data quality will result in a reduced error and in turn, decreased medical claim denials.

4. Avoid Speculation, Focus On The Real Reason For Denial

Better understanding the reason for denial will help in resolving the claims. Recognizing the root cause of the claim will bear better results instead of going off of presumptive explanations.

5. The "Preventing Denials" Mindset

Prevent denials, not just at the explanation level, but rather every aspect of the revenue cycle. By focusing on patient accounting, case management, medical records, coding, contracting, compliance, and patient access.

6. Automated Recognition Of Denials

Having an automated system able to recognize and flag denial claims early on in the billing process will save time, money, and resources.

7. Collaborate With Payers

Working together with payers will help in decreasing speak denial after a billing denial.

Careful analysis of collected data will help in a successful appeal.

8. Managing Medical Denials

Most hospitals are not necessarily equipped with experienced staff and necessary technology to handle claim denials. With constantly evolving guidelines, regulations, and layer rules hospitals can become overwhelmed.

Medical Practices in the Northern California region choose Horizon Revenue Solutions to streamline their medical billing process. We're able to work with any software and are able to bring a personal touch in an industry fraught with two-day wait times just to hear back. Give us a call today at (415) 787-3202 and will get you set up with a specialist.


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