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.