Tag Archives: outsource

To Outsource or Maintain In-House Services: What You Need To Know About Medical Billing

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If there is one thing most practicing health care providers can agree on, it is the necessity and complexity of medical billing. Without effective billing operations, a health care practice cannot maximize profits, limiting its overall contributions and effectiveness in a community. 

Whether people like to admit it or not, a medical practice is a business, and to remain functional and beneficial to a community, it must place some emphasis on collections and accounts receivable. Unfortunately, most small practices are not equipped to handle this complicated and laborious task, meaning they quickly become inundated with past due accounts, leading to a decline in net collection rates and an increase in denied claims. 

A possible solution to the medical billing conundrum is outsourcing. Many private or small practices often want to keep billing in-house, but that choice can increase expenses and is not feasible for many operations. Outsourcing billing services is a practical option with tremendous upside, but there are several things to consider and understand before moving forward. 

The Advantages of Outsourcing Medical Billing Services 

As health care practices grow, many find a growing need to outsource billing services, but it is not only an option for expanding operations. Most startups can benefit from outsourced billing because of the lower costs and unpredictable patient volume. Outsourcing the billing department is an excellent option for practices that do not want to deal with an administrative team. 

Outsourcing allows a practice to focus on medicine and caring for patients. Doctors do not have to take the time to hire, train, and manage billing staff. They also do not have to worry about staff turnover, vacations, or sick time delays. 

Finally, outsourcing allows a practice to reallocate space and funds. A business can convert space for billing teams into functional practice areas. Also, the unpredictable expenses of in-house teams are transferred to a set percentage of operational costs. 

The Need for Outsourcing 

When assessing the need for outsourcing medical billing services, a practice should consider its current operations and expectations. Several questions to ask might include: 

  • Are accounts receivable too high? 
  • Is the practice’s net collection rate declining? 
  • How complex are the coding and billing standards for the practice’s specialty? 
  • Is the practice finding it challenging to maintain adequate billing staff? 
  • Are technological issues (software, hardware, IT, etc.) causing disruptions? 
  • Are billing operations taking away from the medical focus of the practice? 

While this is not an extensive list of questions, it is a decent beginning to figuring out whether outsourcing is best for a practice. If an owner answers yes to most of the above questions and others, outsourcing is likely a good choice for their operations. 

However, many operators need to come to terms with what outsourcing entails before signing a service contract. When a practice outsources its billing services, it means all day-to-day billing functions are handled offsite. Still, offsite management does not necessarily mean less or more restricted access. When hiring a professional and qualified service, an operator still owns the data. 

The Risks of In-House Practices and the Need for Change 

While there are several advantages to keeping billing services in-house, like greater control, ease of communication, and experienced billing personnel on-site, the practice must maintain such operations for the right reasons. Sometimes, an owner keeps an unsustainable in-house billing operation because of ego — the sense that no individual or service can handle operations better than themself. 

Confidence is crucial in business, but ego is detrimental. An inflated sense of self leads to slip-ups and operational errors that cost a practice more than funds; it costs longevity. Many businesses fail because of owner or operator mistakes. 

The decision to maintain in-house medical billing services is an acceptable option, and it might even be the right choice for some practices. Still, it is crucial to acknowledge that a decision made today is not set in stone. Operational needs change as a business evolves, meaning that while outsourcing might not be necessary today, it might be tomorrow. 

The Task of Identifying Potential Medical Billing Services 

If a practice determines that outsourcing billing services is a practical and acceptable solution, it must take the time to identify legitimate companies. The primary criteria for any medical billing service are certification and HIPAA compliance. 

Additionally, a practice should verify a service’s experience. While a company might claim 10 years in the billing industry, does that equate to 10 years of medical coding and billing experience? 

A qualified service should provide references that are comparable to the scope, size, and specialty of interested practices. The company should also explain the qualifications of its employees. 

Before hiring any service, the practice owner should ask to communicate with the individual who will be responsible for the account. It is best to schedule a meeting in person. The face-to-face interaction can help resolve any unmitigated feelings of doubt or uneasiness. 

A practice owner will require frequent updates and reports about the financial state of their business. It is best to arrange for the regular delivery of such information, typically weekly. Additionally, how will the service deliver the data — in person, over email, by phone? Knowing how a service communicates is essential to developing a working professional relationship. 

Finally, the owner will need to determine what items a prospective service handles. Not all billing service companies will deal with everything related to billing. Clarifying the specifics of a contract is necessary for avoiding any missteps. Most billing companies will make arrangements to meet the client’s needs, but those changes will affect the client rate. 

Medical billing is one of the most complicated aspects of operating a health care practice, and it is often the least enjoyable part of managing. As a medical practice owner, there is nothing wrong with searching for help outside of in-house teams. For help selecting and sorting through the numerous billing services available, contact Billing Direct, which provides a list of top medical billers based on specific practice needs. 

When to Outsource: A Comprehensive Guide to Different Billing Providers

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In the health care industry, in-house employees do not always have the time or availability to keep up with billing processing. While billing is essential to all businesses, few share the challenges that health care practices face. Regulatory requirements, patient copays and insurance providers create a long process for practices to manage. Instead of burdening their staff with billing, physicians may choose to outsource to third-party billing providers. 

Understanding the Knowledge Billing Providers Offer 

While medical billing and coding go together, they are two different elements of the overall process. Understanding how complicated it can be to navigate billing underscores why experts in the field are necessary to ensure proper billing practices. 

Medical Billing 

Medical billers submit the bills to patients and health insurance providers. They use medical codes to communicate with the insurance providers about the types of treatment the patient received. In addition to ensuring that the bill is accurate, medical billers also ensure that the bills follow the requirements of the law. A billers job is to communicate with all parties and negotiate payment. Often, medical billing providers use the services of billers and coders. 

Medical Coding 

Medical coding changes every year. Staying up to date takes an effort that many hospital managers and employees do not have time for. Sometimes, managers have too many responsibilities to stress over an in-house team of coders in the facility. Physicians in smaller practices may not know a lot about medical coding. They cannot manage an in-house team realistically because they won’t know if the group performs to the highest standard. 

Medical coders assess clinical statements and assign codes using the classification system. During the billing process, physicians must submit claims to the insurance provider. The coder needs to check three different sources to find the correct codes. 

Coders use the 10th revision of the Internation Statistical Classification of Diseases and Health Problems (ICD), Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding Systems (HCPCS). The ICD-10 classifies diseases and illnesses, whereas the CPT classifies specific procedures. The HCPCS, on the other hand, covers any services not in the CPT. 

Choosing Between Types of Billing Providers 

The goal of medical billing companies is to submit health insurance claims and follow up on the claims. When working with third-party companies, understand that different types of providers adhere to everyone’s various needs. 

Not all practices are built the same, and neither are billing companies. Some services may fit small practices, whereas others may fit hospitals within an extensive network. For example, one facility may need billing support 24/7, whereas others have fewer patients and less need for around-the-clock support. 

Light Service 

Light-level service still requires the physician’s practice to have professionals in coding. The practice handles coding validation, eligibility checks, rejections and authorizations in-house. Many software vendors offer light service to health care practices. The vendor assistance is limited, so the hospital or practice needs to have someone available to move claims. 

Medical billing software automates the billing process. While the software is efficient and accurate, there is little personal touch. 

Full Service 

Many health care practices require complete services. A full-service billing provider is what it sounds like. The company offers comprehensive services to the facility. The health care manager does not need to have an expert in billing or coding on the team. 

The billing provider works for the health care company from the early stages of the revenue cycle. They provide technology and training to check demographics, eligibility, insurance card information and more during the check-in. Next, the company works with the practice and communicates how to handle denials or rejections. When rejections happen, billing providers may provide tips to avoid rejections from occurring in the future. 

With a full-service provider, an expert is available to answer when a facility has questions and concerns. Without consultations, it is easy to fall behind on billing and payments. 

Boutique Companies 

Boutique companies are more minor, specialized providers. When using a smaller company, the boutique may go beyond what standard claims submission and management companies do. They may offer more oversight or have specialties that health care facilities may have difficulty finding. If a health care company wants a billing provider to handle multiple components of the business aspects of health care, boutiques may be more appropriate than other businesses. 

Taking Advantage of the Benefits of Working With a Third Party 

Before a practice decides to outsource billing, they have to determine if it is worth it. The main advantages include providing the practice with more control and a more sustainable approach to the revenue cycle and preventing internal teams from becoming overburdened with billing tasks. 

Fewer Errors 

Medical billing can take up to 50 days from the service to receiving payment. Some practices may have outstanding claims for over 90 days. The more errors in the process, the longer it takes for the health care facility to receive payment. When outsourcing to an experienced, knowledgeable third party, the company should provide up-to-date services free of errors. Medical billing providers are on top of health care regulation changes. 

Fewer Costs 

Billing errors can cause a hit to a facility’s revenue. Additionally, when a hospital outsources, it saves on an in-house team. When managing medical billers in-house, there are various expenses. Hospitals need to pay for training, insurance, benefits, software and payroll. Outsourced billing naturally reduces fixed costs. 

Transparent Data 

Some managers fear outsourcing will take control out of the facility’s hands. The third-party team will still provide data on the payments, collection ratios and denial rates. A reputable and experienced company provides health care facilities with regular performance reports. 

Finding Billing Providers With Billing Direct 

Physicians cannot afford mistakes with hospital billing. To avoid an overworked staff and billing errors, hospitals and health care facilities may consider the help of talented, qualified third-party providers. Managing an in-house team may be complex and could overburden the hospital’s staff. 

At Billing Direct, we help connect health care managers with billing services. Our website contains information about medical coding and billing services, billing education and billing software. Check out our quote tool for billing providers, categorized by practice type.