Deciding whether or not outsourcing medical billing is the right thing to do for your practice can be a difficult decision. However, it should be as easy as deciding whether or not to perform your own appendectomy. Medical billing has always required a specialized set of skills, and in the last few years we’ve seen a steep increase in complexity and red tape. Whether you are a new practice startup, experienced veteran, or in the midst of turmoil like upgrading to a new system, referring to a specialist makes a lot of sense.
A local medical billing company providing revenue cycle management services has become a necessity. Profit margins are shrinking in the private sector due to reduced carrier allowances, increased regulation and carrier red tape. Operating efficiently is now more a matter of survival than it is good business sense.
A billing service distributes their expenses across the entire client base providing an economy of scale. They can operate at a lower cost than a single practice and those savings are passed on to you. A billing service can afford to hire the best staff possible, so you pay less for the same and often higher collection percentages. In addition to the direct financial benefit of higher returns and lower costs (overhead, staff, insurance, hardware…), you save in the more difficult to quantify areas of time, stress, and office space.
The team only has one purpose, to increase the profitability of your practice. They review and post all payments ensuring that the carriers are paying the correct amount and preventing incorrect adjustments. Every outstanding claim is tracked until it is processed and paid to its fullest. This is not a separate team. They are integrated with your existing staff and have the same goals in mind. If the practice does not make money, the billing service doesn’t make money. They work closely with office staff to ensure an efficient overall workflow and provide training when needed. The practice also gains access to a large combined knowledge base of billing experts to aid in navigating the ever increasing industry changes.
Many people think that outsourcing medical billing means giving up control to someone else. The opposite is true, and for most practices, they feel more in control than ever before. Someone else is taking care of the time consuming work and dealing with the headaches, so the providers have breathing room to review their monthly reports and see at a glance the health of the practice. Monthly and annual comparisons are quickly made and all questions are addressed by account managers in detail. Things like charge entry errors or payer reimbursement issues can be identified early before they spiral out of control. Transparency and the ability to run any report 24 hours a day gives a sense of control that they never had before. Adding an expert billing team to the mix utilizes a team approach to progress toward mutual goals.
The healthcare landscape is changing at an unprecedented rate and Medical Billing is not spared from the upheaval of change. Keeping up with the ever changing rules and requirements is difficult under the best of circumstances. It requires constant education and vigilance. New and deleted CPT codes come out annually, Fees change, and carrier rules seem to vary daily. Most people just don’t have the time needed to dedicate to this task.
Billing in-house puts your practice at greater risk for revenue interruptions due to unplanned employee absence or staff changes. An outsourced medical billing service means that you have a whole team of people making sure that your claims get processed quickly and accurately, leaving your practice less vulnerable to disruptions in cash-flow. Many medical billing companies can also provide services on your existing EHR/Practice Management software, which means you won’t have to learn a new system in order to outsource your billing and reap the benefits of managing a smaller staff.
A medical billing service can provide the benefit of a vast knowledge-base and just as importantly; they are privy to aggregated trends from a network of other practices. This inside information keeps them on the cutting edge and shared knowledge is transferred to the practice in real time. Real time information can be invaluable when the change is fast paced and unprecedented.
Cash flow is key! Your days in AR, or revenue cycle time, has a significant impact on your bottom line. Outsourcing medical billing to a billing service can submit your claims faster and with fewer errors, so you receive payment from payers in the shortest amount of time. Your payments are posted by professionals who will prevent errors in payment posting, resulting in denials being detected upfront. These are worked and resubmitted for timely payment. A professional billing service will ensure that you are transmitting claims electronically to all possible carriers and are set up to receive ERAs, further reducing turnaround time. Achieving the highest reimbursement possible in the shortest amount of time puts money in the bank and not on the books. Do you know what your average Medicare cycle time is?
You spent all those years in school to become a doctor so that you could enjoy a long career helping people. Little of that time was spent learning the intricacies of medical billing. Doing your billing in house requires a lot of time and effort. Even if you aren’t the one that actually spends 15 minutes trying to contact a carrier to follow up on a single claim, you will still need to deal with the high level management and all of the headaches that come with it. A billing service can free up a substantial amount of time that could be spent with patients or for some much needed R&R. With age comes wisdom and at some point you may ask yourself “what is my time worth to me compared to what I can pay someone else”. A billing service is an ideal way to free up your valuable time while maintaining the same patient volume and potentially increasing your revenue at the same time.
A good outsourced billing service will only charge a percentage of the money that they collect. The less money that is erroneously adjusted off or the fewer claims sent out incorrectly means more money in your pocket. A good billing service will conduct a fee schedule analysis to make sure that you are getting reimbursed at the highest possible rate for your carriers, utilize multiple claim scrubs to ensure that claims are submitted correctly, utilize efficient policies and procedures to reduce your cycle time, and their experienced staff will review denials for accuracy. Each EOB is audited for correct payment, and steps are taken to ensure that you receive accurate reimbursement for your services. A good billing service works hard to improve your collection rate because if you make more, they make more. Most practices that hire a billing service see an increase in revenue and a decrease in cost that far outweighs the billing service fee.
Now these are just a few of the reasons why it’s a good idea to outsource your billing to specialists. There are some exceptions to the rule where it may be better to do it on your own. For instance, if a large part of your business provides cash services, like laser treatment or your population is mainly self-pay, you may consider doing it yourself. If you choose to go this route, make sure you carve out more time, not just to follow up on outstanding claims, but to stay up to date on carrier rules and regulations.