As a medical provider or medical practice owner, you might have had some sleepless nights caused by medical billing issues at your practice. And it got worse as the challenges were exacerbated at the start of 2022 with the inception of the No Surprises Act and the heavy penalties for non-compliance.
In addition, the current labor shortage dilemma in the USA, and especially in the medical industry, is not making life easier for practice owners when it comes to hiring and retaining competent medical billing and coding teams.
That is why medium and small medical practices nationwide are now choosing to outsource their medical billing services.
The outsourcing of medical billing services in US is on the rise and will continue to do so until the end of the decade. Recent studies from Grand View Research showed estimated the global medical billing outsourcing market value in the region of 11.1 billion US dollars and is expected to grow at a compound annual growth rate of 11.3% until 2030.
The North American region was responsible for the largest chunk of revenue in the medical billing outsourcing space and accounted for 47.5%.
In this article, we will examine some of the most common issues that led to the rise of outsourcing billing functions to medical billing companies and the solutions they offer to small practices in America. We will also offer advice on what to look for when choosing a medical billing company.
Reasons why a small medical practice would use a medical billing company
If you want to give your eyes a break from reading and would rather want to watch a video about boosting medical billing reimbursements instead, feel free to press play on the video below.
A solution to the current labor shortage
The labor shortage in America will continue to increase over the next decade due to various reasons that we reported on in one of our previous articles. Just to reiterate, a study conducted by consulting firm Mercer, projected a shortage of 29,400 nurses by 2025. This is the reason why Filipino nurses, in person and digitally, are rushing to the aid of the American medical industry.
However, the problem goes beyond patient-facing staff like nurses. Finding skilled medical billers and coders and retaining them is also becoming problematic. This takes us to our next point.
Lower employee costs
With the job market being as hot as it is at the moment, small practices find it hard to recruit and retain medical billing teams. Here today, gone tomorrow, as we explained in our previous article relating to the great resignation.
Due to the high demand for labor, the in-practice staff is more likely now to keep their ears to the ground in search of higher-paying jobs. Practices then have to struggle to fill vacant positions, have less salary negotiating power, and lose money and time onboarding new staff members. All of these problems are taken care of when a practice collaborates with a medical billing company.
Lower software and equipment expenses
Licensing fees, upgrading hardware, and replacing old or broken office equipment are all expenses that medical practices can get rid of when outsourcing their administrative functions. Fewer people in the office not only means fewer expenses but also less space.
Small practices that outsource all their administrative functions have the freedom to move to smaller premises where they could also save on rent.
The No Surprises Act of 2022 introduced new legislation to prevent surprise billing and introduced heavy bills for non-compliance. For instance, if providers charge patients more than the in-house cost-sharing amount for services covered by the NSA, providers could receive penalties of up to $10,000 per violation.
Medical practices that outsource their billing and patient verification function mitigate the risk of penalization as the outsourced medical billing solution offers expert staff who are meticulously monitored on the other end.
Medical coding changes occur often and is sometimes missed by in-practice personnel because they are more focused on doing their routine work instead of doing research to see if they are doing everything, according to the book.
A medical billing company has teams behind the billing grafters that pro-actively search for and apply code changes. Then there are also the teams doing audits to make sure that the right codes are used. This leads to a reduction in errors, which decreases delays or rejections and ultimately leads to improved revenue cycle management.
A medical billing company could offer a contact center omnichannel solution. In short, this entails the accumulation of all correspondence between the practice and the patient, which studies revealed leads to an improved patient experience for the practice.
Calls are transcribed and analyzed by AI to determine caller sentiment. Every channel of communication, whether by phone, email, text etc. is centralized and available to agents at any given time. This allows the virtual staff to provide information faster and also communicate in a manner that best pleases the patient. For instance, accounts receivable communication is done more effectively by incorporating such technologies that improve communications.
Improved analysis and reporting
A wise person once said: “That which is not measured does not matter.” This is especially relevant when it comes to improving revenue cycle management. How can you improve it if it is not measured and reported properly?
Data analytics and detailed insights into the medical billing operations allow medical providers to get a better understanding of revenue cycle management. A medical billing company with the right resources can provide detailed information that in-practice personnel can’t or sometimes don’t have time for.
Medical providers can determine how often and how detailed the reporting from the medical billing company should be and also suggest the key metrics that they want to monitor and improve. These could include metrics such as:
- Rejected claims
- Denied claims
- Billing Turn-around time from insurance companies
- Coding errors
- Patient detail errors
- And whatever else the medical providers deem to be important.
Integrating services and optimizing operations
Small practices find it easier to create synergy between the various administrative functions through collaboration with a medical billing company. Most medical billing companies offer different solutions that seamlessly integrate and complement one another.
For instance, it would be beneficial to integrate functions such as medical billing, coding and benefit verification. In a small practice, the billing and coding is often done by a back-office staff member and the benefit verification handled by the same front-office person that is also responsible for scheduling, taking calls, handling marketing etc. Miscommunications occur easily in this manner and could lead to billing errors and money falling under the table.
It is also more beneficial from a reporting point of view as an eagle eye could be kept on the total revenue cycle.
What to look for in a medical billing company
As you can imagine, after learning about the future scope for growth in the outsourced medical billing space, it offers the opportunity for many new companies to open their doors. They would probably offer reduced costs to start digging for market share. But as is the case with every new venture, there is always a learning curve to conquer.
Be vigilant and source a medical billing company that has conquered the learning curve already or you will end up paying for their trial and errors.
- Focused on small-to-medium medical providers
Some companies offer medical billing as a part of their total product offering, and such companies are not that familiar with the intricacies of medical practices. On the other hand, some larger players may focus on providing stellar billing services to their large clients like hospitals and neglect the smaller practices.
Ensure that you find a medical billing company that focuses on small and medium medical practices to enjoy the best quality of service.
- HIPAA compliance and high-tech resources
It goes without saying that the medical billing company you select should be HIPAA compliant. In addition, also try to find out more about the technology they use and how they can integrate with your practice.
The integration itself could be complicated and costly if the medical billing company is not up to spec with its business processes. This brings us to the next point.
- Check testimonials for credibility
Copywriters are evil. They have a magical ability to turn text into spells that hypnotize readers. Don’t just trust what you see on social media or the website of a medical billing company. Try to source testimonials and reviews from external parties such as Google reviews.
This will give you an indication of their expertise in the field and also give you an indication of how long they have been in the game.
- Offering bundled solutions
Synergy is what you get when you integrate different services, as we explained before. Make sure that the company offers different services that you can integrate. Perhaps you are only interested in billing services for now, but the odd is overwhelmingly great that you would want to integrate other services at a later stage.
- Short term commitment
If you want to experiment with outsourcing services to a medical billing company, make sure that they don’t tie you in with long-term contracts. If the service is now what you expected, you might have to pay penalties to exit the contract prematurely.
Try and find a medical billing company that understands the value of freedom which will allow you to exit in the short term. A medical billing company with confidence in the quality of its service doesn’t need to tie you down for the long run.
- ROI orientated
In a previous article, we explored the benefits and ROI of medical billing management services. Make sure that you partner with a company that is focused on return and also offers a guaranteed improvement on the billing cycle.
Such a medical billing company is not easy to find, but they are out there if you search carefully.
Neolytix is one such company that ticks all the boxes required by small practices in America relating to their billing needs.
Neolytix has been focusing on providing a-la-carte services to small-and-medium practices for over a decade. Whether you need help creating an outsourcing strategy or improving your existing outsourcing initiatives, our experts, from billing to credentialing, patient verification, coding, marketing, and more, can assist you.
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