Seven Benefits to Outsourcing Medical Billing


1. Economies of Scale

There are many steps to medical billing that require different skill sets and experience. A billing service distributes the work over multiple people based on their expertise; they can do this because the volume of work justifies all of the full time positions. This is more much difficult for an individual practice, which often needs only 40 percent of a charge entry person, 35 percent of a reimbursement specialist, 50 percent of a collections agent and 15 percent of a reporting analyst.

By spreading the volume of multiple clients across an entire company, a billing service is able to deliver the same or better results at a much lower cost. If practices really analyze the fully loaded costs of maintaining their own billing staff, including wages, benefits, vacation time, space, computers, office supplies, recruiting, training, etc. they often find that 30 percent or more of their cash collections are going to support their billing infrastructure. An established billing company will reduce that cost by more than two thirds.

2. Dedicated, highly trained Specialists

In many practices the staff responsible for billing wears multiple hats. While they may have considerable medical billing knowledge, they simply don’t have the time or focus to become true experts. This is especially true as the rules, regulations, and incentives change on an ongoing basis. Most billing companies price their services on a success basis, meaning that they don’t get paid unless you get paid. This means their team only has one purpose: to increase the profitability of your practice. They work closely with office staff to ensure an efficient overall workflow and provide training when needed.

3. Gain Control

Many people think that outsourcing medical billing means giving up control to someone else. Actually the opposite is true; once practices are freed from the minutia of claims processing, they can spend more time managing their businesses. In many cases, billing companies provide reporting capabilities that far exceed what practices had been used to producing. Productivity & collection trending, adjustment & denial tracking, and coding reviews are just some of the metrics that help practices better understand and manage the health of their business.

4. A Changing Industry

The healthcare landscape is changing at an unprecedented rate, and medical billing is not spared from this upheaval. New and deleted CPT codes come out annually, fees change, and carrier rules seem to vary daily. There is an alphabet soup of incentive programs (TCM, PQRS, PCMH, CPO, CCM, etc.) that exist to maximize reimbursements but the eligibility requirements are complex and time consuming. Keeping up with the ever-changing rules and requirements involves constant education and vigilance, and is difficult even under the best of circumstances. As the traditional fee-for-service model is replaced with value-based care incentives, it will become critical to partner with someone who can help with this enormous transition.

5. ICD-10

The transition to ICD-10 is the biggest change to hit the medical billing world in years. The number of DX codes will rise from 13,000 to 68,000 and a substantial increase in payer denials and decrease in cycle time is expected. Medical billing service providers have a vast knowledge base and are privy to aggregated trends from a network of other practices. This inside information keeps them on the cutting edge, and real-time knowledge-sharing can be invaluable when the change is fast paced and unprecedented.

6. Get paid faster

Slow revenue cycle time has a significant impact on your cash flow. Outsourcing to a medical billing service provider can get your claims submitted faster and with fewer errors. Medical billing service providers ensure that you are transmitting claims electronically to all possible carriers and are set up to receive ERAs, further reducing turnaround time. Claims Scrubbers and Rule Engines detect denials at the front end of the revenue cycle management process, allowing them to be re-worked and re-submitted for timely payment. A good billing company will increase the cash coming in and reduce the cash going out. This simple formula is increasingly important in an era of declining reimbursement rates.

7. Focus on what you do best

You spent all those years in school to become a doctor, and none of that time was spent learning the intricacies of medical billing. In-house medical billing requires a lot of time, effort and knowledge. Even if you aren’t the one actually processing claims, you need to manage the person who does. Do you know the right questions to ask? Do they? A billing service can free up a substantial amount of time that could be better spent with patients or some much needed downtime. If you still aren’t sure if outsourcing is right for you, ask yourself this question: “What is my time worth to me?” You may find that a billing service is an ideal way to free up your valuable time and increase your revenue at the same time.

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