5 Medical Billing Red Flags

December 11, 2019

As we close out another year, or better yet, another decade, the team at Medical Claims Consultants (MCC) has served our mission by bringing results to hard-working medical providers by making sure their medical billing was consistently covered and done so based on new law changes and regulations. We continue to find the passion to do our work because of amazing medical providers like you.

We’re not just celebrating a decade. Beginning 2020 we are launching our 25-year anniversary campaign. As a thank you, we will be delivering expert tips to new clients on how to improve your medical billing process through newsletters like this. The content we deliver comes from real-world experiences and will help you understand how to fix issues within your revenue cycle.

In this month’s edition, we talk about the red flags you need to look for when working with in-house or outsourced vendors.

Spotting red flags

We’re sure you’re familiar with this quote, “never settle for anything less than your best.” With that said, how do you know when your best is not good enough? These red flags below will help you understand if there’s trouble within your medical billing process. Whether from your in-house team, or outsourced provider.

#1- Lack of Efficiency

Is your medical billing in-house team or outsourced vendor frequently double checking claims or fighting high amounts of claim rejections and denials?

In our 25 years, we have seen billers do countless errors, some examples to include, report incomplete data, late claim filing, unbundling of services, unauthorized claim adjustments. These issues will prevent a medical practice to have a healthy cash flow.

#2- Lack of Communication

Are you getting a clear response from your in-house or outsourced biller? There’s nothing worse than a runaround. If you can’t have a productive conversation with suggestions or questions, there may be a hidden agenda preventing you to see reality at hand. A good billing company or in-house biller’s response should point out workflow suggestions to make your revenue cycle better. Waiting weeks for a response to a request is not normal.

If you can’t get a clear answer to these medical billing questions, you have a red flag.

#3- Poor Transparency

If your practice isn’t getting the reports that you want, you should be nervous. Your billing team or vendor should be able to accommodate your data requests. Hiding info, or simply “forgetting” to share it is a sign of mistrust. Key numbers that show your clinic’s true performance shouldn’t be difficult or time consuming to generate if your biller has a good internal process.

#4- Not meeting Benchmarks

Make sure your KPIs are on the mark with those in the industry. Are the numbers really as good as they sound? Look deeper at your benchmarks and ask your in-house or outsourced biller if you’re currently and consistently reaching them. We recommend these to be looked at on a constant basis: days in A/R, reimbursement per visit, and percentage of rejected and denied claims.

#5- Not staying up to date

In our industry, staying current is everything. You need a team of experts with years of experience and that are re-certified to meet standards. Having informed billers who stay up-to-date on laws and code changes is vital to compliance and consistent quality.

>> Click here to grab the PDF version of the checklist <<

Choosing the correct partner

It all comes down to results. If you are reading this as a doctor or administrator, ask yourself these two questions. How much money are we losing per year, and on average, how long is it taking us to get paid? The right partner not only can answer that question, but can show you results.

Why MCC is the perfect partner

When comparing us to an in-house or outsourced medical billing team, the main thing that sets us apart is our incentivized approach. If we don’t collect revenue for you, we won’t get paid. For over 25 years our clients have stayed with us because we work with urgency, professionalism, and are the experts in medical billing.

Testimonial from our clients

When a Florida hospital saw no insurance collections for months, it faced potential closure. Claims submitted were denied due to lack of biller’s knowledge of insurance claims submission requirements, as the in-house billing department claimed ignorance. With the billing system unable to generate reliable reports, administrators were at a loss to explain the drought.

The team from Medical Claims Consultants (MCC) was hired to conduct a revenue cycle audit. They found hundreds of denied medical claims that had not been worked or refiled correctly.
After 30 days of a complete audit including all supporting documentation, MCC refiled over $800,000 in claims within filing limits. Lost, however, were untold thousands of dollars in timely filing claims that had aged out.

But thanks to MCC, the hospital returned and stayed with positive cash flow.