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Healthcare is increasingly moving to a “consumer driven” model. The good news is that consumers are demanding the right to choose their own practitioners and financing, but the bad news is that this means consumers must also be the sole decision-makers when problems arise.
Caught in the crossfire of this evolving model are medical practices who are finding it increasingly difficult to operate under decreased revenue and increased operational cost. Add to this the ever changing coding and billing requirements forced by large health benefit payers like Medicare, Medicaid, and BC/BS, and some practices are finding it easier to have a professional billing company handle the complexities of their billing. Finding the right out-sourced medical billing company can turn the billing process into a smooth and financial rewarding experience.
Following are some of the key factors practices weigh out when considering to outsource their billing to a third-party medical billing service company:

  • Increasing complexity of reimbursement calls for specialized skills of coding
  • Reduced rate of reimbursement requires a professional to negotiate your contract.
  • Passing of benefits coverage to patient calls for additional steps in collecting patient balances.
  • Negotiating payer contract rates requires knowledge of coding, billing, and the reimbursements rates in the practice vicinity (RVU’s), and these are generally known by a professional billing company.
  • Practice staff turnover and absenteeism leads to disruption of cashflow
  • OIG requirements on medical billing practices calls for a professional billing and coding professional to oversee billing.
  • Ensure that Best Practices for timely filing, claim follow-up, denials, and collections are diligently adheard to.

Needless to mention, these values can be only derived from professional and qualified medical billing companies.  Practices often fall prey to inexperienced medical billing companies resulting in revenue loss and cash flow disruption.  Practices should check for proper references from reliable sources to ensure that the responsibility of the critically important revenue cycle management of the practice is bestowed in the hands of the right medical billing company.
According to medical billing experts AMBS, there are many clearly measurable advantages of outsourcing your medical billing activities:

  • No downtime due to staff turnover or staff absenteeism
  • No training and re-training, absenteeism
  • No employee benefits
  • No delay in cash flows during absenteeism
  • No computer hardware / software headaches or expense (i.e. upgrades, trouble shooting…)
  • Increased, more predictable cash-flow
  • Increased incentives (we work on a percentage of collections)
  • Most current coding & reimbursement techniques
  • Increase accountability
  • Full-time, professional attention to your cash flow
  • No office distraction
  • Increased office morale
  • Detailed management & negotiating reports
  • Pre-sorted mailing for quicker delivery (Claims & Statements)
  • Daily electronic filing
  • Increased patient satisfaction (due to prompt, accurate and professional filing – and their calls being answered within two rings!)
  • Free your office to do what you do best…Care for your patients!

Practices’ feel they lose control over revenue, AR, write-offs and financials by engaging a billing company. Being in control of financials is an important of a business; this can be accomplished by engaging billing companies that use web-based software that is tightly integrated with their practices scheduling, electronic health record and reporting. Practices should be able to run real-time reports with key performance indictors that depict key financial matrixes. The alternative could also be asking billing companies to use their in-house software for billing purposes. The in-house software should be secure and web-enabled through pure web technology such as java, or asp; such that the productivity of the remote billing company is not affected due to application speed. Applications using Citrix, Microsoft remote desktop sharing, gotomypc etc are often found to be counterproductive accessing remotely due to speed issue.
To summarize, the value derived from a medical billing company can be tremendous, particularly for small and solo practices. These benefits can be reaped only through an effective collaborative partnership with the right medical billing service company.

Last Updated on July 13, 2016

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