A new industry of high-technology medical billing has mushroomed under the auspices of its promise to streamline the collections process and leave doctors with more time to care for their patients. Though many high-quality services and systems exist, an overwhelming variety of options and attractive (yet unsubstantiated) performance claims from some providers have charmed busy doctors into making poor strategic decisions for their practices. Collaborative billing knowledge base improves medical practice profitability and compliance.

Excess focus on reducing costs of individual billing process components while ignoring total billing quality exposes medical practice to significant financial downside. Quantification of billing quality and its inclusion into price-performance equation of billing service yields more comprehensive financial picture and better decisions about billing service selection and its management. Such computation of relative value of billing quality also results in substantially higher remittance and better regulatory compliance. Its efficacy depnds on billing performance guarantees and transparency.

Can an outsourced medical billing service improve or expedite payments and reduce costs? This article revisits key arguments for and against billing outsourcing in light of increasing complexity and regulatory scrutiny of billing processes.

Electronic Medical Record (EMR) and digital billing systems offer substantial clinical care, financial, practice workflow, and compliance benefits to doctors, insurance companies, and patients. But half of medical practices that purchase EMR software fail to successfully implement it. Upon briefly reviewing key factors defining each technology, we compare them along two criteria, namely implementation success likelihood and costs.

According to BillingWiki, thirteen articles and news items were published on the topic of medical billing fraud, during May of 2006. An environment of high volume of patient encounters creates thousands of possibilities to deviate from normal distribution of services and trigger an audit. Real time analysis requires powerful technology infrastructure and competent legal coverage. Such infrastructure must handle all compliance aspects together, which necessitates modern Vericle-type integrative approach, combining billing, monitoring, and medical record management components in a single and comprehensive system.

The reduction of accounts receivable is key responsibility of billing function in a medical practice. This article compares traditional (distributed) billing function with centralized workflow management. It shows that centralized workflow management yields significant advantages over the distributed approach in terms of the ability to manage accounts receivable. However, it also requires significant investment in process, technology, and personnel training.

Billing performance measurement is an integral part of medical practice billing process and a prerequisite to effective practice management. Systematic measurement becomes mission-critical with growth of billing complexity or outsourcing of the billing function. Traditional billing metrics are limited in scope and focus on claim submission process, ignoring process imperfections on the insurance (payer) side. Modern computer technologies allow both productive measurement and effective action by the disciplined billing office to improve claim submission and payment processes.

Over four thousand vendors of medical billing services offer solutions to medical practices nationwide in response to poor in-house billing performance and increasing regulatory scrutiny of billing processes. On one hand, such a large number of outsourced billing solutions ensure continued competitiveness in terms of both service quality and pricing. On the other hand, the lack of uniform service standards and metrics among the vendors, combined with their large numbers, makes the process of vendor selection difficult and error-prone. While the availability of a large vendor selection allows finding an alternative to unsatisfactory service, billing vendor-switching costs remain high, motivating extra effort and focus during the stage of vendor selection. This article outlines basic thirteen-step guidelines for an effective and efficient medical billing vendor selection process.

Medical billing industry has volumes of arcane terminology and payer- and time-dependent claim validity and pricing interpretation rules, facilitating massive payments of invalid or ineligible claims and denials of error-free claims. Billing service transparency allows participants of the billing process to expedite error identification and resolution, resulting in reduced over-and under-payments and improved regulatory compliance.

Medical billing complexity and massive volumes of daily claims submitted to payers render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight Through Billing addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists to exceptions only. Straight Through Billing methodology implements billing service transparency and focuses management on strategic process improvement opportunities.