This guide will help you, as a patient; navigate the medical billing process from the moment you contact a healthcare provider about an appointment until after you receive your bill in the mail. We discuss how healthcare providers determine costs and negotiate charges with your insurance provider. Finally, we show you how to identify and dispute erroneous charges on your bill.

Let us discuss these concerns and try to make it easier in understanding this model of pricing:

1. Percentage pricing model:The percentage pricing model is also called the ‘success fee’ model, since the outsourcing company gets paid for its services based on successful collections. The percentage pricing model is a ‘win-win’ situation, since the outsourcing company gets paid only based on the collections. So the onus for doing everything possible to increase the collections of a Practice or Medical Group rests with the Outsourcing Company. The collections that are included for the percentage calculations will typically be the Gross collections that include both payments from the Payers, Patients and Self-pay category.
2. Scope of services covered:The biggest disconnect with the Percentage pricing model occurs while understanding what all Services are included.  Typically all the Revenue cycle services will be included that include – Demographic entry (if applicable), Coding (if Providers do not code), Charge Entry, Claims transmission, Handling the Transmission rejections, Payment Posting, AR follow-up and Denial Management.  Sometimes, Credentialing, Insurance Benefit Verification and/or Patient calling can also be included for a slightly higher fee.

One of the reasons why the Percentage fee is always customised and there are no standard rate cards, is due to this customisation that is possible, along with variations in Specialities, Collections, Software etc.

3. Benefits: There are many benefits associated with the ‘success fee’ model.  The primary one being, payment based on performance only. The other benefit is that the medical billing and collections are now handled by professionals who have the singular mission of improving the Collections for the Practice/Medical Group, as their fee is dependent on it.  This eliminates wastage, improves efficiency and faster cash flows

Medical Billing Service Average Costs:

• Most of the medical billing companies charge a percentage of collections. Typical rates are between 5% to 10%, although it is possible for rates to be 4% to 15%. This is a major earning incentive that will make you more money. They don’t get paid unless you get paid.
• Some services or speciality billing services (i.e. Medicaid/Medicare specialists or other compensation specialists) charge a flat fee, per claim. Fees range from$1 to $8. A typical practice often pays $4 to $6, per claim. Make sure to find out if the cost of submitting inpatient and outpatient claims is separate.

Cost of service can be a deceiving and is, ultimately, not the only way to select a billing company. A service may demand a higher percentage of profits. However, their performance will often boost your total collections. The resulting increased revenue may quickly account for the difference of paying that slightly higher rate.

A common criticism of EMR (electronic medical records) use in medical practices is that it causes doctors to become less engaged and impersonal.  This causes frustration for all parties – patients and physicians – because doctors didn’t sign up for computer duty and patients expect a doctor’s full attention during visits.

For example, an EMR allows a physician to track data over time, easily identify which patients are due for preventive screenings and vaccines, and monitor and improve the overall quality of care within the practice. Doctors use specialized software, enabling a patient’s complete history to be available immediately.

EMR Software:

EMR software has made it easier to store large amounts of PHI. When it is stored and transmitted electronically, it is referred to as ePHI. It has also changed the way that doctors are able to access ePHI. EMR software allows doctors to search by specified criteria and cross reference other doctors’ notes from one place.

Software Advice, a website that reviews medical software, recently did a survey on how to improve doctor-patient interactions in the EMR era.  They listed the top seven tips received on maintaining quality relationships:

1. Position your computer between you and the patient:No brainer here.  Face the patient during interactions.  Take the time to plan where your equipment will go so that this is possible.
2. Smartphone and Tablet Apps: EMR software has other implications. Many doctors are now reporting accessing ePHI through their smart phones and tablets. A new market has emerged for apps related to management of EMR. Recent software developments have made it possible to create a doctor-patient portal in which the doctors and patient can engage in a virtual dialogue and share information without needing to be face to face. This provides care and attention in addition to the scheduled appointments.
3. Invest in mobility:Whether it’s a small rolling desk, small tablets or other lightweight tools, choose equipment that helps you move around.  A laptop may cost an extra buck but can be worth the investment.
4. Transitioning to Virtual Platforms:  Some may argue that this could lead to a dependence on technology   and a reduction in actual face-to-face time between the doctor and the patient. While it is always important for patients to maintain regularly scheduled appointments with doctors, these developments in EMR software         and applications allow doctors to provide care and effort without the constraint of physically being with the     patient.
5. Ignore the computer when you first enter the room:Chat with your patient for a few minutes before you start recording information in the digital record.
6. Ask about previous complaints:If the patient information is pre-loaded, look over it before entering the room.  If they have open complaints, ask them about the issues to close them out in the EMR.  This reaffirms to the patient that you care.