What To Expect From Medical Billing Companies In Massachusetts

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According to the latest rankings from the U.S. News and World Report, the second-best hospital in the country is Boston’s Massachusetts General Hospital. It is one of the best medical centers in the Bay State, ranking first in Psychiatry and second in diabetes and endocrinology. Statewide, the average margin for hospitals was 4.5% in 2018, according to data from the Center for Health Information and Analysis.  Margin is the amount wherein a hospital’s revenues exceed its expenses. Hospitals should monitor revenues to sustain their services.  And one effective strategy to increase revenue is by outsourcing its medical billing system. Medical billing companies in Massachusetts offer a variety of services.

Here are some benefits that hospitals should expect.

Enter data charges

Billing companies handle medical coding.  Based on the medical diagnosis, statistical codes are assigned to track diseases.  These codes are evaluated by insurance companies to assess coverage.

Some medical billers are certified by taking exams – like the Certified Medical Reimbursement Specialist (CMRS), Registered Health Information Administrator (RHIA), and Certified Professional Billing (CPB).

Handle claims

Medical billing companies in Massachusetts submit claim applications to insurers electronically or by paper (if necessary), ideally within 48 hours.  Early submission means fewer errors and faster reimbursements.

Billing companies follow up on any denied claims and more aggressively on delayed claims. They strategize on soft collections and the setup of payment plans to run after bad debt.

Prepare management reports

Medical billers provide management with regular progress reports to help them assess the financial health of their medical practice.

Provide software support

Medical billers have extensive experience in various software solutions – from electronic medical records (EMR) to medical practice management.  Therefore, they can share their expertise in the software system.

Alert management on compliance changes

As industry experts, medical billing companies keep themselves updated on health care laws like the HIPAA, Health Care Reform bill, and the Massachusetts Health Insurance Penalty.  While health professionals are busy with their patients, these billing companies keep management up-to-date on compliance requirements.

Suggest ways to improve billing and collection of specialists

Each medical specialty will have its billing requirements. This applies to all fields whether it is radiology, dermatology, or pediatrics.

Since medical billing companies in Massachusetts have worked with doctors in a variety of specialties, they are in the best position to suggest best practices as far as billing and collection is concerned.

Assist in EDI and EFT enrollment

Medical billers can assist in enrolling in Electronic Data Interchange (EDI) and Electronic Fund Transfer (EFT), a necessary step before submitting Electronic Media Claims to Medicare.

Handle front-end claims scrubbing

To submit correct claim applications to insurers, medical billing companies use scrubbing software to ensure error-free billing codes.  Doing so will reduce the incidents of denied and rejected claims.

Post transactions through ERA and manual EOB

Paid claims have a supporting document called “explanation of benefits” (EOB).  The EOB explains how the application was processed as well as the payment details. Manual posting of large amounts of EOBs can be time-consuming and costly.  Medical billers verify the EOB to ensure that the payment is correct before posting.

The Electronic Remittance Advice (ERA), however, eliminates the need for paper EOB.  The ERA mentions whether the claim’s approval or denial, its final status, and any adjustments if made.  Since the remittance is received electronically, the medical billers can review them online.


These are the benefits of getting medical billing companies in Massachusetts.  While focusing on patient care, hospitals have the assurance that their billing is professionally handled.

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