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Billing Companies: Billing Systems, Medical Claims, and Cycle Management

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Medical billing companies can help healthcare providers to boost revenue, manage health insurance claims and reduce the risk of loss. Outsourcing your billing services will give you access to leading experts in the medical billing industry who can resolve most of your billing issues in no time.

Read further to learn what a top billing company is, what services they offer, and the systems they use.

What is Medical Billing Company?

A medical billing company is an organization that performs the invoicing process of a medical practice. They are responsible for managing patient care facility data, medical coding, and submitting bills to reimburse the money. The billers ensure that the medical practice is compensated for their services by invoicing both payers and patients.

A professional medical billing company leverages modern medical billing software, establishes rules, and creates a well-structured method to error-free bills. Some companies also offer cloud medical office software to ambulatory medical practices. They will also follow up on medical insurance claims to save time and energy. With medical billing team support, a healthcare provider can ensure to generate revenue and improve cash flow.

Types of Medical Billing Systems

There are three types of medical billing systems that billing healthcare practice uses. Medical billing companies may work with healthcare providers based on their billing systems.

Here are the three major types of billing systems that a medical billing provider may offer.

Closed Medical Billing Systems

This refers to a billing system in which related health records and billing charts are kept safe within the particular healthcare domain. Electronic Medical Records (EMR) are one of the most preferred digital tools that contain all data of every patient. It is used for treatment charts and managing patients’ information. While you can connect EMR with other EMRs within a company, no one outside the company can use it, except for a top billing company.

Who Can Use a Closed Billing System?

This type of system is ideal for stand-alone healthcare providers or medical practices with fewer physicians and a smaller scale. Wondering how EMRs are used? They can do various functions in your medical facility.

Some of the benefits you can enjoy are:

  • They help you track vaccination programs.
  • Providers can monitor and track a patient’s vital parameters through the system.
  • Doctors and other healthcare staff can check patients’ due dates for checkups or preventive screening.
  • Healthcare experts can connect several EMRs to create a proper treatment plan.

Open Medical Billing Systems

In open billing systems, patients’ data moves across several facilities. Typically, all primary stakeholders in clinics or hospitals have access to the system, including patients, healthcare organizations, doctors, staff, third-party vendors, and billing teams.

Electronic Health Record (EHR) transfers patient records to different sectors and provides more detailed information than EMRs. Unlike EMR, EHR is not restricted to the boundaries of the clinic. This is because healthcare professionals and patients can monitor and edit the information in the open billing system.

Who can Use Open Billing System?

Healthcare practices on a larger scale with several departments can choose an open billing system because of its ability to share information. Practices who want to outsource their billing services should opt for open medical billing systems as it makes the transmission of information easy and seamless.  

How do practices use EHRs? There are several features and benefits of EHR that make them the best option for most businesses.

  • It’s easy and allows access to different specialists and departments within a single healthcare organization to access the data on it whenever they want, making diagnosis and treatment easy for healthcare providers.
  • EHRs include sensitive information, and electronic health records of a patient, such as demographic factors, past test results, allergic reactions, previous diagnosis, and any present or past medications. Hence, it contains the medical histories on a single platform.
  • A laboratory and imaging center can access EHR if they have to take tests.

Isolated Medical Billing System

Instead of a healthcare organization or provider, patients can maintain isolated billing systems with the help of PHR or Personal Health Records. Patients can incorporate their health records into it, maintain them, and provide them to the doctor for convenience.

While this doesn’t directly participate in the billing structures of an organization, it can help healthcare facilities get all the patient information, which they can provide to billing service experts.

Who Can Use Isolated Medical Billing Systems?

Only patients can use this system, and it has the following benefits.

  • Patients can maintain their medical records to avoid misunderstanding and errors and provide it to a healthcare provider.
  • PHRs can provide a holistic view of existing and prior medical conditions and treatments when generated for doctors, nurses, administrative staff, and other medical team members.
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I'm very thankful for Portiva who I know is looking after my practice while I'm gone the virtual assistants can manage prescription refills, documents they can triage patients and just kind of answer administrative questions and they can handle a lot on their own. But also, they're very good about contacting me if there's any emergency or anything I need to attend to. So I'm very thankful for Portiva they can help almost any provider almost anywhere and it really allows for some good work-life balance as I'm getting to experience right now at my family farm so I'm very thankful for Portiva and I'm very happy to use their services"

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Portiva's Virtual Medical Assistant - I have all the support I need. There's somebody checking my email, any patient messages. Patients are still able to schedule and handle any scheduling issues and any kind of billing that needs to still go through. Portiva hands handles it all for me. I have support i have somebody that I can access 24/7 pretty much. It's all very seamless. If somebody has an emergency or needs a medication called in. I know that the va's at portiva will handle that for me.

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Mohammad Ashori, M.D.

Board Certified Family Medicine Physician

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What Medical Billing Services Do Medical Billing Company Offers?

Medical billing service providers are great for medical groups and healthcare facilities. Professional billers can maximize your revenue and claim timely reimbursements. Best medical billing companies provide a number of services to medical practices that help them achieve their goal and grow in the industry.

Here are a few services that a provider might offer you.

Enrollment into the Billing System

When a biller claims reimbursement, they need to submit complete patient information. This is why most billing providers greatly focus on patient enrollment. The medical billing company will electronically enroll patient data from the hospital’s system, such as:

  • Insurance information
  • Demographic information

Insurance Verification

Verifying insurance benefits and patient eligibility is the most critical part of the billing process. Experienced and top qualified billing company performs the eligibility verification procedures. They also verify the patient’s active healthcare coverage by contacting the insurance organization and checking the policy status, type of plan, claims mailing address, plan exclusions, deductibles and co-insurances, patient responsibilities compromising co-pays, effective data, and other things.

Medical Coding

The medical billing company will quickly and precisely turn medical information into codes. They help you accurately manage CPT coding, DRG/ICD-9-CM coding validations, medical coding audits, and other related coding methods to offer optimal reimbursement. Note that the right coding is important to get approval for claims on which the company’s revenue cycle management depends.

Reconciling of Accounts and Billing

Experts of medical billing service providers focus on all phases of the billing process, such as calculating self-accounting totals, collecting monthly bills, handling the transfer of funds, and much more, to offer optimal revenue for a healthcare organization. Some major areas they cover are reconciliation, cash posting, and charge entry.

Insurance Authorization

Getting insurance authorization is the most important but time-consuming process. A credible medical billing agency uses reliable methods to perform this task efficiently. The billers will contact the insurance company and get the assurance that the insurance provider will pay as early as possible for the services the patient got. This service reduces the risk of last-minute cancelations and maximizes cash flow.

Accounts Receivable Collections

Your hired medical billing service provider will offer quality account receivable collection solutions to help the medical practice deal with credit and patient collections issues. They offer a professional solution for:

  • Patient collections
  • Insurance collection
  • AR collections and follow up

Billing Services

The best medical billing services providers have a team of experts who are skilled, experienced, and trained in medical coding. They also have AAPC-certified coders, accountants, administrative staff, and other supporting professionals. The medical billing firm utilizes advanced medical software to get accurate results. Most importantly, the best medical billers in the market follow medical reimbursement rules and regulations to get billing claim approvals.

How Much Do Medical Billing Companies Charge?

When looking to hire medical billing companies, you should know that they charge you based on different factors, such as your company size, the complexity of billing claims, specialty, volume and value, facility needs, and the systems you use. However, the cost of services can vary greatly by billing service providers. Many companies ask for a percentage of your total reimbursement, usually between 3 percent to 7 percent.   

Some medical billing agencies also take definite monthly fees to offer medical billing services to perform your billing process. It’s best to discuss the payment method with your healthcare practice before hiring them. This will allow you to choose a company that comes within your budget and with which you can work for a long time.

Bottom Line

When it comes to medical billing companies, there are several billing processes they can help you with. These companies provide you with a number of medical billing solutions that improve your cash flow and boost your revenue. However, choosing the right medical billing company is crucial.

You need to look for a medical billing service that offers solutions suitable for your current medical system. Also, your budget is the primary factor in deciding your ideal billing firm. So, keep these things in mind before hiring a top billing company.

The affordable medical billing services cost help medical facilities with revenue cycle management, denial management, medical coding,

 If you are looking for the best medical billing company in the healthcare industry, Portiva is here to help you. We are a team of experts who provide different services and help medical experts to achieve their goals. We have a proven track record, and with our help, you can improve your practice management and eliminate errors in your medical billing process.

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Frequently Asked Questions

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What is a billing company?

A billing company is a company that provides invoicing services to healthcare practices, medical billers, and medical claims departments to manage the revenue cycle management of a course. These services can include medical billing, healthcare data management, and healthcare data management and invoicing solutions. The primary function of a billing company is to ensure that all medical billing are organize. If you need invoicing services in the U.S., particularly in Florida, check on healthcare data management to learn more about how a billing company can help manage your practice's financials.

What are 3 different types of billing systems?

Various billing systems are available to meet the needs of different industries and organizations. The three standard billing systems in the healthcare industry are medical billing services, revenue cycle management, and healthcare data management.

Medical billing services involve outsourcing the billing process to a third-party provider, such as a company specializing in medical claims like Portiva. This can be an excellent option for healthcare practices needing more resources to manage their billing.

Medical revenue management is a more comprehensive solution that involves managing the entire billing process - from coding, medical claims and data entry to claim submission and follow-up. This approach can help healthcare organizations maximize their revenue by ensuring that claims are processed accurately and efficiently.

Healthcare data management are another billing system that can help organizations manage their billing more effectively. These solutions may include automation tools or software to streamline billing processes and reduce errors.

In the U.S., the top medical billing services and revenue cycle management providers are widely available, offering a range of options to fit the needs of various practices. Click here to learn more about the best medical billing services in the industry today.

A solid billing strategy is essential for any healthcare practice looking to maximize revenue and improve its bottom line. With the help of top-tier billing services and other healthcare solutions, medical billers can effectively manage their billing processes and optimize their medical revenue management practice like what some BPO company do.

What is an outsourced billing company?

An outsourced billing company refers to a third-party organization that provides medical billing services to healthcare service providers and practitioners in the U.S. This type of management practice is increasingly popular among healthcare professionals who prefer to focus on their medical training and leave the billing and account management to experts. Outsourced billing companies offer several billing services, including claim submission, payment collection, and HR services. Outsourcing billing services allows healthcare providers to save time and resources while ensuring claims get managed effectively. Contact an outsourced billing service to compare their service offerings and discuss how their management practices can benefit your practice today.

Which is best company for medical billing?

When choosing the best company for medical billing, numerous options are available in the United States. However, if you're looking for top-notch services to manage your medical billing needs, you should consider some of the leading companies in the industry. These companies specialize in services like medical claims, billing and data solutions and offer comprehensive healthcare management for medical billers.

Some companies that dominate the medical billing industry in the U.S. include revenue cycle management organizations, such as OptumInsight, nThrive, and Portiva. These companies provide excellent billing services for healthcare providers, focusing on medical coding, statistics, and data analytics. These companies use data models to help clients improve billing revenue and practice efficiency.

Choosing a medical billing company that fits your practice's specific billing needs can be rigorous. Before deciding, consider factors like the company's experience in your field, customer support services, and the pricing structure. With the right medical billing partner, you can automate administrative processes while maximizing revenue, and a reliable medical billing company can help you achieve that.

What is the main objective of a billing company?

The main objective of a medical billing company is to provide healthcare practices with efficient and accurate billing services, allowing them to focus on clinical management and patient care. Medical billing services include managing claims, outsourcing and managed billing reports, and providing back-end support to clinical practices. Outsourcing medical billing helps practices to compare and show how their product or service is performing, allowing them to manage their billing and revenue cycle more efficiently. A managed billing service can also provide HR management and surgery billing services. In short, the primary aim of a billing company is to take care of the necessary administrative tasks related to revenue management, allowing healthcare practices to focus on their core operations of delivering quality healthcare services to their patients.

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