Medical Claims Processing 101

Medical claims processing is not task that most would consider fun, but it is a reality of life in the business of medicine. Most medical offices specialize in taking care of patients so medical claims processing may seem like a daunting task. It doesn’t have to be, however, if you select the right solution for your business.

Here are some questions to ask yourself as you prepare to make a decision:

1. Do you have the money to hire someone to handle billing in house?
2. Do you need the expertise of a company to help?
3. Will a simple software solution be sufficient?
4. Can you easily change your solution as your business needs change?

How to Decide if You Need a Medical Claims Processor

You will first have to take a good look at your business and determine what your greatest challenges are. What resource do you find you are the most short on: staff, time, or money? What size is your organization? If you are large and process complex claims, you may want to hire a professional. If you are a small office that processes a relatively small amount of simple claims, software may suffice.

Hiring a Medical Claims Processor

If you decide to hire someone to work in your company, Keep in mind that there will be expenses such as salary, vacation, sick days and other benefits for the employee.  The benefit to hiring this person is that they will know your clinic and services well and will have the ability to form relationships with clients. The downside is that hiring in-house is typically the most expensive option in the short term.

Hiring an Outside Company

Hiring an outside company is a great way to get the benefits of hiring an in-house professional without the overhead that additional staff can bring. There are many reputable companies (such as Billing Advantage) that can provide a variety of services to meet the needs of your business as you grow and change. Hiring an outside company can have the benefits of hiring someone in house combined with the flexibility of software.  This is a great option if you are looking for a combination of expertise, adaptability and reasonable pricing.

The Software Solution

Billing software is always an option, but keep in mind that you assume more risk with this solution. Software is typically the most cost effective in the short-term, but keep in mind that you could be hit with hefty fees or lose money if something goes wrong with the software.  Software also places the burden of collection on you and your staff, so you have to make sure that someone will have adequate time to deal with issues that arise.

There are many things to consider when selecting a solution for your medical claims processing solution, but if you consider your options from all angles you should be able to find a solution that works for your business. Of course, we’d be happy to start a discussion with you about your medical billing needs.