Take the Complexity Out of Medical Billing & Insurance.
Practolytics’ Virtual Medical Billing & Insurance Services help healthcare practices streamline billing, claims, insurance follow-ups, payment posting, and revenue cycle tasks. Our experienced virtual teams help reduce delays, minimize revenue leakage, and keep your practice financially healthy.
Virtual Medical Billing and Insurance Services for Practices Seeking Reliable Remote Billing Support
Medical billing and insurance can be a lengthy process to manage for your practice. If you’re not staying on top of your patients’ insurance claims and following up with them to ensure they are up to date, you’ll get unnecessary claim issues, unexpected patient costs, and additional admin.
By outsourcing key aspects of your virtual medical billing and insurance services, you can get expert help when you need it. You can outsource processes such as eligibility verification, benefit verification, claim preparation, and payer follow-up. A clear process can be put in place to help your team manage front and back office processes to allow you to focus on providing care to patients.
Virtual Medical Billing and Insurance Services
There are numerous administrative tasks involved in dealing with medical insurance during every patient interaction, including ensuring the patient is covered, checking benefits and authorizations, making claims, and dealing with the insurance company. This can be time-consuming for your administration team.
Virtual medical billing and insurance services allow you to gain support from a remote team. They will handle specific elements on behalf of your practice but will do so using your systems and processes.
Depending on services required, you will gain different levels of support. These include:
Levels of Support
- Verify patient insurance eligibility.
- Confirm patient co-pay, deductible, and coverage.
- Prepare and submit insurance claims.
- Monitor claims and payments.
- Follow up on rejected or outstanding claims.
- Gather billing data and reports.
- Ensure a consistent process is in place to support patient access and the revenue cycle.
What Are Virtual Medical Billing and Insurance Services?
Hire remote professionals to perform specific insurance and medical billing tasks. Our team will work with your approved practice management system, insurance payers, and communication platforms to complete required tasks.
An insurance billing service can be specific to claims and payer chasing; however, some practices only require help with insurance verification. This involves verifying that the patient has the correct coverage and benefits. Other practices prefer an all-round service, which can be provided by:
A systematic service can provide:
Insurance Verification
Check if their insurance is valid and obtain any insurance details.
Benefits
To find out what co-pays, deductibles, co-insurance, and visit limitations they may have.
Claims
Prepare and submit claims.
Payment Tracking
Find out if there are any balances due and responses from payers.
Manage Denials
Identify any issues with claims and help resolve or appeal.
This may form part of wider health billing services and billing management solutions; it’s best to confirm exactly what will be carried out to ensure that you know what tasks will be completed on your behalf.
How Our Virtual Billing Process Works
We can help ensure you have a uniform process to make sure you are reviewing your insurance information at the correct times and not missing any of your billing tasks. We can design a workflow that fits with your appointment schedule, payer mix, and current administration.
An example could be:
Initial Assessment
What size is your practice? What type of specialty do you offer? Are there any specific insurance details you need to know? What systems are you using? Do you have any issues with billing?
Data Capture
What data do you need from patients, providers, and payers?
Pre-Visit Check
Insurance confirmation prior to visits.
Claims Review
Claims review for completeness and alignment with insurance details.
Submission
Submission and monitoring of claims per the agreed process.
Corrections
Coordinating with any corrections, outstanding claims, and denials.
Updates
Providing agreed-upon updates on what has been done, what is still outstanding, and any issues.
Insurance verification services for medical practices may be included; however, it can also be used for outsourced patient insurance verification for additional houses.
Works With Your EHR and Practice Management Software
Ensure the billing is not disrupting the current technology. Every medical practice will have different EHR systems and practice management systems to store patient details, book appointments, medical insurance, and claims. Support must be delivered remotely in a way that fits in with the system’s current access and capabilities.
Before beginning, you should ensure that your software is understood by the service provider. They should be able to do this within the software. They will need to be able to access appropriate records, edit permitted fields, and securely view billing details.
This could include
- Current EHR or Practice Management solution
- Access to any existing payer portals or clearinghouses
- User roles and remote access are needed.
- Current Insurance Verification/Claim Processes
- Reporting and Communication Preferences
Insurance Billing Services We Handle for You
Insurance claims are a complex process that requires accurate pre-booking information and consistent post-booking processes. We can provide a range of services, including insurance checks and selected insurance claiming activities.
Insurance Eligibility and Benefits Verification
- Active or Inactive Policy Status
- Copay and Deductible
- Coverage Coinsurance and Benefits
- In-Network Information
- Visit Limits and Referral Requirements, as Applicable
Our insurance verification services can be used by doctor’s offices to check insurance availability ahead of an appointment. Depending on the availability of payers and information provided, we can verify the items listed.
Verification of benefits for patients can help medical practice staff to identify patients’ possible out-of-pocket costs. However, this does not guarantee that the patient will pay, or that they are eligible for a specific service.
Virtual Verification Before Appointments
Virtual services for insurance verification can be used within a clinic setting to aid front-of-house processes. Being able to complete insurance verification support before appointments will provide early identification of issues with coverage and allow your practice to follow up with patients/payers for any further information needed.
Claims and Billing Follow-Up
Depending on the scope agreed, these can also include the activities listed. This helps link the insurance verification with the overall billing process.
Scope can include
- Production and submission of claims.
- Monitoring of claim status.
- Coordination of payment posting.
- Review of rejected claims.
- Follow-up of denied claims and coordination of appeals.
- Tracking of outstanding accounts receivable.
Why Choose Practolytics?
To find a great partner for your remote billing, you’ll need to understand what services they provide, how they work, how they will communicate with you, and how they manage patient data. You want something that will integrate well with your practice and give you control over key aspects of your practice.
We can help you understand what you need and discuss how we can provide a service that will work for you. Consider the following questions:
Roles & Responsibilities
Clear definitions of roles and responsibilities
Insurance & Invoicing
Clear process for ensuring the correct parts of your insurance and invoicing are addressed.
Your Workflow
Clear processes for ensuring your current appointment, documentation, and claims processes are followed.
Escalation Process
How will you deal with any exceptions, missing data, or urgent issues?
Reporting
How will you report the completion of tasks? What claims and issues will you need to resolve?
Access
You should ensure that remote staff only have access to the areas needed to complete their specific role.
Before starting to onboard a new member of staff, ensure you have checked the service agreement, costs, security, and reporting process. This will ensure there are clear expectations from your practice and the remote team.
Benefits of Virtual Medical Billing and Insurance Services
Outsourcing billing and insurance can be a great way to ensure your practice has good admin. This means that they are able to give certain tasks to a team that works remotely.
Benefits may include:
Save time on administration
Saves your team time on repetitive insurance administration and chasing invoices.
Ensure compliance
Ensures your insurance is in check prior to appointments to ensure there are no gaps or lapsed policies.
More efficient invoicing
Having clear processes in place makes it easier to manage claims and outstanding work.
Flexible support
You can discuss what support you need in relation to your workload and invoicing.
Regular reports
Regular reports can help flag any outstanding claims or verification issues.
Room to grow
Access to remote support can give extra administrative resources as your practice grows.
The value of healthcare online billing services can be measured by looking at factors like verified claims, accepted claims, denied claims, AR, and staff volumes. This will be impacted by how the payers react, how well documented the claims are, how easy the system is to access, and the service provided.
Conclusion
Virtual billing & insurance can help your medical practice with eligibility checks, benefit checks, claims, and chasing up with the appropriate payers. Choosing the right service will depend on your practice’s systems, specialties, number of appointments, and admin systems. If you are outsourcing this, you want to make sure you understand who will be doing what, how you will receive information, what the cost will be, how secure it will be, and escalation points.
We can review your current process and discuss how we can support remotely. Having defined responsibilities and clear processes means that your team will be able to run your billing efficiently whilst maintaining control of your practice.
Virtual Medical Billing and Insurance Services FAQs
1. Will I lose control of my billing if I outsource it?
Yes. You can maintain control of how you are billed. In the service agreement, it will detail all services you will get from your remote team, what you need to approve, and how you will be kept informed and given reports.
2. What results can I expect, and how do you measure them?
Your results will be based on what you’re currently doing, who is paying for services, how good your documentation is, and the range of services offered. Possible useful KPIs may be how many patients are being seen by you at this stage, claim acceptance rates, trends around claim rejections, accounts receivable days, and chasing up outstanding claims. You can then see what your current position is.
3. Do virtual billing services support my specialty?
Many billing processes can be tailored to suit your medical specialty. Payers and documentation requirements will differ. From our preliminary assessment, we can assure you that we can help by knowing your niche, services offered, payers, and what issues you are experiencing.
4. Is outsourcing medical billing better than hiring in-house?
This will depend on your current workload, budget, and management availability. If you want to have some flexibility but don’t want to commit to employing more permanent employees, then an outsourced team could be the right choice for you. Alternatively, if you do require an on-site team all the time, then an in-house team may be the best option.
5. How long does it take to get started?
Depending on your systems, authorizations, service needs, and training needs, you will have a certain amount of setup time. A simple verification process and not much outsourcing of billing tasks will save you on setup time. We can give you an indication of how long it should take once we have done our initial assessment.
6. Will virtual billing work with my EHR or practice management software?
It will depend on your platform, available access, and requirements. Ensure you mention any software you are using so that the provider can confirm they can support the process.
7. How do virtual medical billers handle insurance claims and denials?
Virtual billers will create, submit, and track claims. They will determine why claims were denied by the payers and make any necessary corrections or appeals. They will also track outstanding claims and provide updates to your practice. Final decisions and approvals will be made by the relevant authorized personnel.
Take the Complexity Out of Medical Billing & Insurance.
We can review your current process and discuss how we can support remotely — with defined responsibilities, clear processes, and you in control of your practice.