Third-party Medical Billing Companies

When it comes to medical billing, we often tend to feel the same concern as diseases themselves. The world of insurance companies and medical billing is extremely extensive, so much so that there is even a career dedicated only to this activity, called “Medical Billing and Coding”. Although we can find a lot of information related to this topic on the internet, if you need advice, it is best to hire the services of medical billing companies.

Generally, we have a basic knowledge about medical billing and the effects of taking out health insurance. However, we must be extremely careful when it comes to hiring and paying medical bills. It is not something we should take lightly.

In this article, we will explain how these companies work and their important contribution to the current medical world.

What Does Third-Party Mean In Healthcare?

By saying “third-party” we could interpret that it is a person outside of 1) the patient and 2) the institution that provides medical assistance, for which it’s inferred that the medical billing companies are the third-party in this legal transaction.

These companies are hired to manage payments and other claims of a specific medical center; their main purpose is to “reimburse” and manage the expenses of a patient’s medical care.

Generally, this entity is known as a “third-party payer” can be a private insurance company (which you probably already know), but at the same time, they could be also government payers, such as Medicaid or even the patients’ employers. This occurs when the employer offers (within the employment contract) a guarantee in which it will reimburse the medical expenses of its workers (in these cases, certain conditions apply. For instance, it will only be paid for certain types of serious pathologies).

To explain it more simply, imagine that a patient has hired the services of a medical billing company so that at the end of their medical treatment, the company pays the medical care provider (hospital) the bill for that service.

Likewise, it may be the case that health providers (hospitals, clinics, healthcare centers) have a contract with third-parties payers to reimburse and manage the expenses derived from the medical assistance of all patients.

Top Of Medical Billing Companies 2021

  • Advanced MD: It is the best option by far. It offers a fairly comprehensive and quality service.
  • Athena Health: It is one of the best options for hospitals as it offers fast and efficient service.
  • Kareo Company: If you are an independent physician, perhaps you should work with this company.
  • Chart Logic: For small medical groups, it is currently the best option in the market.

Should I Hire A Medical Billing Company?

Surely you have already wondered if it is worth hiring the services of this type of company, and the answer can be found by evaluating what benefits you would obtain if you do so.

For example, as we mentioned earlier, to carry out the tasks that medical billing companies do (manage expenses and health care claims), the personnel who work there have had to study this career or at least have taken a course on medical billing and coding.

This clearly inspires confidence and indirectly invites people to hire these companies, since many times in hospitals and other health centers, errors occur in billing. When this occurs, the procedures to amend them are usually cumbersome and a long-term one, which only causes more concerns to relatives and patients.

Additionally, remember that these companies are constantly updated regarding the guidelines and other regulations related to medical billing since medical billing codes change frequently, and having at our disposal the services that a medical billing company offers, would undoubtedly be very beneficial when filing a claim.

So it is worth asking yourself: do I know what the medical billing encodings are? Am I able to make the necessary calculations for the reimbursement and administration of medical expenses? If the answer is no, you should evaluate whether the services offered by third-party payers could be useful to you.

What Should I Take Into Consideration When Hiring A Medical Billing Company?

If you have already decided that you want to hire a medical billing company, the second step to follow is to know which company to choose. Many times we do not know what to review before entering into a contract of this magnitude.

To access and manage the health information of all patients, medical health centers and insurance companies must comply with the established legal requirements since clinical documentation is a very important matter and the privacy and security of this type of information must be seriously respected.

This is why, when hiring a medical billing company, you should first check its reputation and ask yourself: is this company known for its good service? Does anyone I know recommend it to me?

Another thing you should keep an eye on is whether the company has a history of compliance with the Health Insurance Portability and Accountability Act (HIPAA), which is nothing more than the law promulgated with the good intention of simplifying administrative processes related to healthcare and protect the patient’s privacy.

Any person or organization that works with documentation related to healthcare must comply with the guidelines derived from HIPAA, and medical billing companies aren’t an exception.

If you are interested in reviewing more detailed information about HIPAA and how to obtain a certification, you can visit this website.

Finally and as a last recommendation, before hiring a medical billing company, go through their website, read the contract carefully (if possible, request orientation from a lawyer or specialist in the area of medical billing and coding), but above all, make your choice based on your specific needs and circumstances.