Medical billing is an authentic payment practice in the U.S. healthcare system that facilitates
reimbursing services from third-party payers through a structured process. Medical billing generates
medical claims which act as billing invoices detailing rendered services in the form of codes, and the
whole procedure involved in it is called the billing cycle and sometimes Revenue Cycle Management (RCM),
which commences with the RCM work model and collects revenue through billing. Without this process or
with inaccurate billing, medical organizations can never gain what's their proper, i.e., reimbursement.
Physicians already have a lot on their plate; hence, assuring accuracy is challenging and distorts their
profit. At this point, outsourcing is a handy approach in which 3rd party billing experts such as MedsIT
Nexus submit clean claims on physicians’ behalf.
This post will clear your confusion by answering frequently asked questions such as why you outsource,
what are the highlighting differences between outsourced billing and in-house billing, the pros and cons
of outsourcing, and what the solution will be to avoid these risks.
There are a lot of challenges that come with in-house billing. To overcome these challenges, healthcare providers consider outsourcing. Some of these prominent issues that urge outsourcing include the cost of managing the in-house billing department and overhead expenses like onboarding costs, infrastructure installation expenses, salaries, benefits, and training costs. Moreover, changing rules, the small size of the team, low turnover, less patient care, and data breaches also interrupt workflow and profitability. Medical billing fines for each data breach are higher as compared to other fields, with the global cost of data leakage in 2023 being around USD 4.45 million (a 15% increase over three years). Due to these challenges and the perks offered by 3rd party billers, physicians are more prone to handle their RCM services to 3rd parties. The result of an MGMA stat poll showed that 36% of healthcare providers chose to outsource their "revenue cycle" when they were asked about the area they wanted to outsource.
In-house billing services | Outsourced billing services |
Physicians have more control over the RCM process. | Physicians have less control. |
High operational cost | No operational cost |
Salaries and benefits | No salaries and benefits |
Need to spend money on implementing & maintaining technology | No need to spend money on technology |
Ease of communication with the administrative crew | Risks of communication challenges |
No expertise | Access to expert and skilled services |
When you handle your finance department to 3rd party vendors, you don't need to spend money on the installation of billing infrastructure; no salary expenses will cost your revenue. A case study highlighted the importance of outsourcing by stating that you can achieve decreased costs when you stop investing in expensive infrastructure such as state-of-the-art technologies. Each external billing platform is specially designed to fulfill every billing demand and assist in escaping overhead costs. These companies follow one of the two specific reimbursement structures given below.
The complexity of the claim, the services provided, the geographic location, and the volume of claims are some factors that determine the medical billing rate.
Billing is time-consuming, as "time well-spent results in more money to spend and more money to save." Busy physicians don't have enough time, so outsourced administrative companies take the responsibility of removing this burden from their shoulders. As explored by a Sermo poll, around 26% of the providers mentioned outsourcing as a time-saving strategy.
Expertise: Top-ranking healthcare billing firms have experienced coders and billers who
use effective strategies to analyze the claim to make error-free comprehensively.
Up-to-date on new changes: Skilled medical billers and coders follow different
protocols to stay updated on new Federal and State laws as well as new rules of coding. These companies
offer ongoing training to their staff. Therefore, their medical coding experts use updated and legal
codes according to the guidelines of insurers and coding organizations.
Technology: These companies implement in-class and state-of-the-art software that
eliminates the burden of implementing quality assurance procedures to stay updated with new policies and
identify any errors in claims before sending them to insurers to ensure no reason for the claim is left.
Regular auditing: Ensuring compliance and correctness through auditing before and after
claim submission is the best service for professional billing because auditing rectifies mistakes, hence
clean claim submission.
Billing involves dealing with and exchanging a lot of private information, which must be secured to avoid HIPAA penalties. Billing companies are safe because they are HIPAA-compliant and more conscious of compliance; hence, they implement safety procedures and inform patients how their data will be used to meet the three HIPAA security standards.
Scalability is the ability to adapt your business, its resources, and operations to meet new changes and updates. Outsourcing assists providers with the services and resources your practice needs and eliminates the distractions and difficulties that hinder growth regardless of size.
External billing experts positively impact revenue by using experience, professionalism, and skills and implementing various auditing strategies to streamline the financial aspects and decrease claim denials: the fewer claim denials, the greater the revenue.
Lack of communication adversely affects medical providers and billing companies. This means Healthcare
providers cannot clearly ask about what is happening with the claim, and billers cannot clear up the
confusion about documented services.
Solution: Before contracting, ask them about the modes of communication and how they
streamline communication using advanced technology.
Handling your billing process to a third party means you have less or no control over your financial
process.
Solution: Ask about their transparency protocol and when and how they will maintain
transparency. MedsIT Nexus provides frequent reports and dashboard services, along with free access to
the cloud, to keep you updated.
Not all billing companies provide the personalized and high-quality services you need for your
practice's high revenue.
Solution: To mitigate this issue, check the company's experience, reputation in the
market, and clients' feedback about the quality of its services. Investigate whether the company adheres
to HIPAA.
Outsourced firms may charge you additional expenses other than fixed charges, which are a great concern
for healthcare organizations.
Solution: Before signing the contract, check for any additional charges and read the
contract carefully to understand all the expenses.
There can be potential security threats associated with the procedure because exchanges of personal
information occur, which can lead to penalties in case of any misuse.
Solution: To mitigate the issue, make sure the billing company is HIPAA-compliant in
using and legally securing information. If a company is HIPAA-compliant, it will follow every protocol
to safeguard your patient information to help you escape fines.
Are you a physician who wants to unlock revenue resources and strategies by professional healthcare billers and coders? Do you want services tailored to your administrative needs to earn profit and improve your reputation in the industry? Wait is over because MedsIT Nexus medical billing company is offering scalable services that integrate EHR, EMR, and other cutting-edge technology, meeting Federal and State laws and complying with HIPAA guidelines to increase reimbursement. We eliminate the administrative burden overwhelming you and help you spare time for better care with economical pricing that suits your practice. So, contact us today and let your practice be in the hands of an experienced medical billing management company.
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