5 Threats That Can End Your Medical Billing Business

The threats to medical billing companies using a traditional model are so severe that most businesses will not survive. 

There are times when continuing to do business the way you always have is an acceptable choice. You may not be as successful as some competitors, but you’ll still be in business. This is not one of those times.

There are five major external threats:

1. Low rates. Billing companies with automatic claim processing software achieve such efficiencies so they can offer practice percentage rates that are half of the industry average.
2. Geographic reach. Using today’s sophisticated, cloud-based software, Medical Billing and RCM companies can successfully serve practices anywhere in the US. Instead of local competitors, you’re now contending with national players with limitless resources like ADP, AthenaHealth, eClinicalWorks, or CareCloud –who all have strong recognized brands.
3. Perceived value. Large billing companies are perceived by physicians as being better simply because of their size. Slick marketing campaigns and professional sales people don’t hurt either.
4. Real value. All of the major national billing companies offer their physician clients free EHR along with guaranteed successful implementation. This benefit is nearly irresistible to doctors, especially those who have experienced a failed EHR implementation or are under the gun to meet Meaningful Use requirements.
5. Secure access and compliance. Today’s cloud-based systems allow physicians access to patient data from any device with an internet connection. They also bring practices into almost instant compliance with HIPAA (32 out of 49 rules), HITECH, Omnibus, PCI, e-prescribing, and now ICD-10.

How can any small or mid-sized medical biller compete against these types of threats?

All is not lost. You can successfully compete against even the largest billing company with the right business model, tools, and a willingness to change.

You can’t combat these threats without a cloud-based, end-to-end system that gives you complete secure access to all of your practices’ clinical information. These ‘unified’ systems automate the tasks that consume your time, so you can turn your attention to helping your practices eliminate administrative waste, shorten their revenue cycle, and increase their bottom line.

With the right system, you can achieve the same efficiencies as the national companies. This will allow you to charge more competitive rates, turn a profit, and offer your physicians a free or low-cost EHR. You’ll also increase your geographic reach: a cloud-based, end to end EHR/billing system lets you serve clients or hire workers across the country.

The best news is that you can do more than just play on the same field as the medical billing giants—you can win.

Here are two significant advantages you have over the industry giants threatening to overwhelm you:

1. Your services levels are higher. Lured in by technology and low pricing, many practices eventually are let down by the commoditized style of the big-name firms. Low rates mean low service levels on claim follow-up, patient statements, revenue recovery, or zero effort to really lower accounts receivable. Practices that contract for the lowest rates quickly see that those rates leave a significant amount of practice revenue unmanaged –as much as 3% of total monthly revenue.
2. You can function like a practice’s CFO. As discussed above and as we mentioned in a older post, your business model can shift from simple claims processing to the Revenue Cycle Management consultant who addresses each financial leak and truly improves the practice’s bottom line.

Picking the right medical billing software means one that provides true RCM features and is an end-to-end cloud based Practice Management System with EMR. Immediately, you’ll have two distinct advantages over your competitors:  your reputation and your client relationship. Instead of a competitor luring your client away with lower rates and better technology, you’ll now be the one offering physicians free EMR and bringing them up to date and into compliance.

It’s unsettling to realize that maintaining the status quo could mean the end of your business, but understanding these threats while time is still on your side, means you can take steps to ensure that you come out on the winning team.

In 2021, the above threats remain valid while more join the array.

According to PriceWaterhouseCoopers, the top health industry issues of 2021 are

1. Healthcare delivery reshaped for virtual interactions – The pandemic was a surprising call-to-action about telehealth and practices around the country have risen to the challenge, quickly adapting to virtual patient visits. In the new year, this system will most likely be more streamlined after wrinkles being ironed out.
2. Clinical trials incorporating more remote aspects – With the release of the COVID vaccine, healthcare companies were forced to limit in-person interaction for their trials and are now releasing that they can curb in-person interaction in future trials as well.
3. Digital tools enhancing clinician experience – The onset of digital reliance especially over the last year has cemented how easy it is to integrate technology into physician care. We can expect to see more investments in automation and physician-patient portals.
4. Healthcare portfolios designed for growth – The revenue stream of the healthcare industry has fluctuated in the past year and now these medical giants have become more resilient “diversifying their capabilities and revenue streams.”