As an independent medical practitioner with an in-house billing team, you’ve likely dealt with various complications throughout the billing process. Billing is a crucial part of every physician practice, no matter the size. To do it right requires dedicated billers and coders, and constant oversight of claims and reimbursements. The billing process as a direct link to your finances makes dealing with these issues all the more pressing, especially today with the threat COVID-19 is posing to your revenues.
As we unlearn, learn, and relearn during these challenging times,
let us explore outsourcing!
Look for these triggers
- Concern that declining revenues will continue beyond the pandemic
- Too many write-offs and high number of denials
- Poorly managed patient receivables
- Your in-house billing expert is pulled to assist in other tasks
- Difficulty keeping up with regulatory issues from government and payers
- Poorly managed 60, 90, 120 days AR buckets
- Software is no longer meeting your needs
There may be additional triggers that are very specific to your practice, but if any or all of the above apply, then it’s time to consider outsourcing. The benefits offset the costs, but better yet, outsourcing boosts revenues and streamlines workflow, making your practice more efficient for patient care.
The many complexities in the revenue cycle process combined with the constant change on regulations and payors rules set up the perfect environment for mistakes, leaving money on the table and impacting your cashflow.
Pros of outsourcing
Whatever the reasons are, most causes of low revenue can be corrected by outsourcing. If you are finding that your revenue is low due to misfiled claims, clerical errors, untimely filing, or errors resulting from CPT and ICD-10 updates, you can expect outsourcing to raise your revenue.
One of the most significant points in favor of outsourcing billing is developing a trusted partner relationship with your professional revenue cycle partner to establish a clear direction to improve revenue and having a comprehensive knowledge of regulatory issues from the federal government and payers.
Your revenue cycle partner makes sure all critical points are properly checked, from demographic data, eligibility, to charge codes, documentation and clearing house, so when the payer receives your claims, they get paid.
Equally important is managing the patient responsibility, issuing statements on a regular basis and collecting patient balances. Additionally, the patients will have a tollfree number to call whenever they have questions about their bill. This is a huge benefit as it frees up your staff and provides a better experience for your patient, improving your patient retention.
Your partner can also help negotiate better contracts with payers if the analytics reveal that the current contract is not working for the physician.
In the in-house model the practice grows its own talent with the appropriate training; however, when you have a small staff and one of them resigns, you have to start from scratch to replace that employee.
In an outsourcing model, there is a team of trained resources available to make sure your claims get paid. You no longer need to worry about training, vacation, calling in sick, late arrivals due to traffic, etc.
Choosing an outsourcing partner requires due diligence as you sift through various options, make contacts, and fully understand their services, compare prices, and so on. This pandemic leaves no choice but to make time to do this right now and avoid rushing into outsourcing your medical billing without doing the needed research.
When not to outsource
Outsourcing may be irrelevant for you if your billing team is highly trained, up to date in their field, and have a proven track record of high returns with 95% or more of claims paid.
Points to consider when selecting a good outsourcing partner
- Proven expertise. The vendor should have a solid reputation and understanding of your needs as a practice.
- Transparency. The vendor should provide clear information up front about the terms of the agreement, fee structure and implementation plans. There should be no hidden costs.
- Current technology. Ask for clarity that the vendor is using the most current technology to get the work done.
- You are not looking for basic skills, but rather a partner who can deliver to meet your billing and revenue cycle needs.