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Outsourcing Medical Billing Services: What You Need to Consider

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September 30, 2021
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Outsourcing medical billing is a great way for practices to increase revenue and expand their teams. The process of outsourcing medical billing services is a business decision that many practices make in order to increase the quality of their services and reduce costs

As most are aware, medical billing is a complex and difficult process. The more time you spend on your medical billing, the less time you have for patient care or other tasks that are critical to running your practice. This article explores the benefits of outsourcing medical billing services to an experienced third-party company who will take care of all aspects of this complex process so you can focus on what really matters: providing quality patient care.

What Is Medical Billing?

Medical billing is the process of submitting claims to insurance companies following a medical procedure. This includes documenting and recording all the necessary information about the patient visit, treatment or surgery provided, as well as this care’s costs in order for your practice to receive compensation from an insurer.

It’s important to note that the majority of insurance companies now have complex and detailed requirements for medical claims, which must be followed to ensure accurate reimbursement. Following these guidelines is crucial to avoiding payment denials and ensuring that your practice receives the maximum reimbursement.

What Does It Mean to Outsource Billing?

It is important to know what outsourcing medical billing means and how it can benefit your practice. Medical billing refers to the act of documenting services provided by a healthcare provider, setting up insurance claims for reimbursement or making collections from patients who do not have insurance coverage.

When you outsource medical billing, that company becomes responsible for all aspects of this process, including both insurance claims and collections. You continue to provide the medical services, while your billing company takes over all other responsibilities related to that patient’s account, making sure everything is documented properly so you can get paid as quickly as possible with minimal hassle.

Differences Between In-House and Outsourced Medical Billing

Differences Between In-House and Outsourced Medical Billing

Many physicians believe their staff or even themselves to be capable of doing all aspects of medical billing. Most believe it’s not an overly complex process and that most practices do have the necessary technology to manage this aspect of patient care. However, there is a lot more to consider when deciding between in-house versus outsourced medical billing services.

  • In-house billing needs to be done by someone who is knowledgeable about medical insurance rules and regulations, which can make this a difficult task for most physicians.
  • It takes up valuable time that could otherwise be spent with patients or on other important tasks such as practice management.
  • In-house billing can lead to costly errors or mistakes due to the lack of experience with complicated insurance claims and regulations.
  • In some cases, in-house billing can also lead to delay of payment and lower reimbursement.

When you outsource medical billing, all aspects of this process are handled by experienced third-party professionals who understand the ins and outs of insurance claims. They will work with your practice management software for maximum efficiency, so that everything runs smoothly on a daily basis and you can focus on providing the best patient care.

Who Should Consider Outsourcing Their Medical Billing Process?

Medical billing can be a full-time job, requiring extensive knowledge of insurance rules and regulations in addition to coding skills. In some cases, it is even necessary for someone at your practice to have prior experience with medical coding before taking on the role of overseeing this aspect of patient care.

When you decide that outsourcing medical billing makes sense for your practice, your billing partner will take care of everything for you. This includes:

  • Ensuring the accuracy and compliance with insurance rules and regulations for all claims submissions.
  • Working closely with your practice management software to ensure maximum efficiency in handling patient accounts efficiently.
  • Developing a customized workflow so that each step is handled by an expert in that particular field.
  • Ensuring all patient accounts are handled in a timely manner, without any delays or mistakes due to lack of knowledge about insurance regulations and rules.
  • Tracking down payment options for patients who do not have adequate insurance coverage so you can receive the maximum reimbursement possible.

When Is It Time to Consider Outsourcing Medical Billing Services?

If you are still manually processing your own insurance claims, then it might be time to outsource this process, especially:

  • When you have a heavy patient volume and not enough staff members or time in the day to dedicate to billing tasks.
  • When there is no one on staff with medical coding experience who can oversee all aspects of managing patient accounts, or if you are not able to dedicate enough time and attention to this aspect of patient care.
  • When in-house billing is leading to costly mistakes due to lack of knowledge about insurance regulations and rules.

Outsourcing Medical Billing Might Be Right For Your Practice When:

  • You want a hassle-free way to ensure proper, accurate and timely processing of all patient accounts.
  • You want to ensure that your practice is always in compliance with insurance rules and regulations, which can be extremely difficult when you are handling these tasks yourself.
  • Outsourced billing services will work closely with your office staff, so they feel confident about their role in the process. This ensures a smooth workflow that is beneficial for your practice.

What Are the Benefits of Outsourcing Medical Billing Services?

What Are the Benefits of Outsourcing Medical Billing Services?

There are many benefits to outsourcing medical billing as opposed to managing this area in-house. Some of the most notable advantages include:

Focus on Patient Care

By hiring an experienced third-party company, you can focus all your attention and efforts on providing quality patient care without worrying about the complexities or difficulties associated with accurate documentation for insurance claims and collections. This is especially important when you are caring for patients in the emergency room.

Improve Patient Satisfaction

Many patients have a difficult time understanding the billing process and getting their claims processed correctly, so they end up paying out of pocket for services (or not receiving payment at all from insurance companies that deny them because of errors made in documentation). When your medical billing service takes care of everything, you are able to ensure that all claims are submitted correctly and quickly, so patients can get reimbursed for the services they have provided.

Ensure Billing Compliance

Compliance is a major issue in healthcare today, as it relates to HIPAA compliance, accurate coding of patient files and documentation of medical services provided. Many third party billing companies work with healthcare providers to make sure they are meeting all standards of compliance, which can help them avoid unnecessary audits or fines from the government.

Reduce Billing Errors

When you outsource medical billing, your billers will have extensive experience in coding and documentation of patient files. This enables them to reduce the risk for common errors such as incorrect or missing diagnosis codes or procedures performed, which can lead to fewer reimbursements overall.

Faster Insurance Payments

Insurance companies often take time to process claims, and this can result in delays for your patients or practices. When you outsource medical billing, all services are sent directly to insurance carriers, ensuring fast reimbursements and decreasing the chance that claims will be denied due to missing information from the physician’s office.

Lower Office Management Expenses

When you outsource medical billing, your expenses related to office management are reduced. This can result in a lower overhead expense for your practice, which means more money available to spend on other important resources or investments such as equipment and staff salaries.

Excellent Customer Service

Working with an experienced third party company will ensure that all of your patients’ needs are met and their concerns addressed, resulting in the best possible service. When your billing company has a successful track record of providing high-quality customer care, patients will be happier overall with this process. This, in turn, can lead to more referrals for your practice as well.

Outsourcing medical billing services is one of the most beneficial options available today when it comes to increasing revenue and efficiency of your practice, so it is important that you consider all of the options available.

What Criteria Should You Look for in a Medical Billing Service?

What Criteria Should You Look for in a Medical Billing Service?

When you are considering hiring an outsourced medical billing company, there are a few key factors that will help ensure their success in this role. They should have extensive experience with coding and documentation of medical files, as well as a familiarity with the latest technology, to make sure that they can maximize efficiency within your electronic health records system or software.

The staff members who handle claims and collections for your practice should have positive attitudes, good communication skills as well as the ability to handle stressful situations. They must also work with you on a daily basis so that they understand all billing policies within your office or facility in order to ensure compliance across the board.

It is important to choose an outsourced medical billing company that has experience with your specialty, such as a hospital or emergency room. They should also be able to handle the specific needs of your facility and provide more than just claims processing services.

How to Find a Reliable Provider of Outsourced Services

When you are looking for a reliable outsourced medical billing company, there are several ways to find one that is right for your organization. You can post the job on an online jobs board or connect with companies through LinkedIn and other social media sites.

You should also check out reviews from existing clients as well as contact references they provide in order to find out more about their success in this role. Before you hire, make sure to check with the Better Business Bureau for any complaints against a company and evaluate whether they are properly certified by Medicare or other state agencies as compliant with federal regulations on medical billing procedures. You want to make sure the company providing the service for you has the same value set as your organization.  They do become an arm of the practice or facility.  I always recommend having someone with some experience at the practice to be the direct contact to the Billing company, checks and balances are important.

Questions to Ask When Interviewing Potential Providers

Interviewing potential providers will allow you to learn more about the company and determine if they are right for your organization. Some important questions to ask include:

  • What is their history with your practice specialty?
  • How many years have they been in business?
  • Do they offer a range of services so that all aspects of medical billing can be handled in-house?
  • What are their past and current clients like?
  • Do they provide a strong customer service experience that will benefit you as well as your patients?

The next step is to sit down with the company so both of you can determine if there is a good fit. This should include determining which tasks they will take over for your practice and which tasks you want to keep in-house. Make sure that the outsourced company is able to handle all types of claims, as well as deal with any specific issues within your state (such as insurance coverage requirements or documentation standards).

Consider Outsourcing Some of Your Accounting Services

Consider Outsourcing Some of Your Accounting Services

In some cases, it may be best to outsource only certain aspects of your medical billing rather than the entire process. For example, you may choose to outsource claim filing with a company that handles all other services in-house and partner with another provider for coding or appeals procedures. Once both parties have agreed on roles and responsibilities as well as rates and payment terms, you can sign an agreement which will outline specific deadlines, goals, procedures for terminating the agreement, and any penalties that may be incurred.

Overall, outsourcing medical billing services is a great way to reduce the cost of your facility and free up time for other tasks. Among the many other benefits, outsourcing medical billing services can reduce billing errors, helping you put greater focus on patient care, improving patient satisfaction in the process.

Organizations looking to cut costs, or those who are overwhelmed with the medical billing process, can benefit from outsourcing and should consider making the switch.

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