Have there been months when the collectible amounts within your practice have been low? Months when your reimbursement for services rendered cannot keep pace with your expenses? If so, then you are not alone. In a system dominated by HMO’s and PPO’s it often requires a great deal of effort and expertise to collect what is necessary to make your practice profitable. Effort spent following up on insurance denials and incomplete reimbursement. Effort that most private practices do not have the manpower or the requisite funds to expend. Today it is becoming common for medical practices to depend on outside service providers for their billing needs. Hiring an outside agency has proven to be a cost effective solution for various reasons. First, it reduces your payroll and scheduling expenses. It also eliminates the headache of finding qualified personnel and the time spent training them. Apart from the monetary savings, physicians utilize billing companies to improve efficiency and to enhance employee utilization within their office, thus increasing their reimbursement level. A physician’s time and effort should be directed towards the patient, not towards the struggle with insurance companies to obtain the highest level of reimbursement. Selecting a qualified billing company should be based on each practice’s specific needs. Importance should be placed on finding an organization that is well established and respected in the medical billing industry. Experience is often the most important step towards solidifying your billing procedures and increasing your reimbursement. A billing company must also take pride in hiring certified personnel who keep up-to-date on the constantly changing rules and regulations mandated by state and federal governments. By understanding these regulations and their implications, a practice will see a noticeable reduction in their claim rejection rate, immediately increasing revenue. A very important consideration when hiring a billing company is location. It is often beneficial to hire a qualified billing service located in or near your own state. This will ensure the company you select is familiar with the laws and regulations in your area and will understand the best reimbursement methods for your practice. In addition to insurance claim handling and accounts receivable management, several billing companies also offer medical coding and auditing, documentation training, consulting and full practice management. Full practice management may consist of a number of services including credentialing, contracting, consulting and financial services. This will benefit all medical providers from hospitals to small, private practices. HIPAA compliance is the hot topic in medicine in recent months. A practice must choose a billing agency based on whether the agency is compliant with the national standards. Civil penalties can cost up to $100 per violation and criminal penalties as much at $50,000 per fine and one year in prison. All medical practices, billing services and clearinghouses must be HIPAA compliant by April 2003. Medical facilities should begin the compliance transition now, rather than delaying the inevitable. Outsourcing may make the shift to HIPAA compliance easier by removing some of the responsibility from the practice itself by hiring a company that is already abiding by the future mandatory national standards. Some websites of interest for more information on HIPAA regulations are www.nchica.org, www.healthprivacy.org, www.hcfa.gov and www.hipaasummit.com. Ms. Mitchell is the Billing and Coding Manager for Applied Medical Systems, Inc., an accounts receivable management company in Durham, North Carolina. Ms. Mitchell has over 10 years experience in medical billing, coding and consulting. . For any questions regarding the above editorial you may reach Ms.Mitchell at (919)477-5152 or at [email protected].