When it comes to savings, outsourcing medical billing services is one of the most important business decisions a medical practice can make. In-house billers are fixed costs that don’t vary based on collections, but an outside vendor’s performance is directly tied to the practice’s revenue. This incentivization transforms all aspects of medical billing services.
Overhead Reduction When You Outsource Medical Billing Services
The costs of managing an in-house medical billing department include staff salaries and benefits, software and training, and the administrative costs of hiring and training staff in one of the highest turnover jobs in health care. When you Outsource Medical Billing Services to a practice, all of these fixed costs become variable overhead, based on revenue growth, rather than fixed expenses, based on staff.
When billing staff turnover happens, it’s a revenue black hole. Know-how walks out the door, and new hires take time to get up to speed, which means a reduction in quality and an increase in denials. Outsourcing eliminates this risk by retaining a dedicated, expert team with no gaps in knowledge.
Coding Accuracy and Compliance When You Outsource Medical Billing Services
Outsource medical billing services providers have certified coders who keep up-to-date with the annual changes in CPT and ICD-10, as well as changes in payers’ policies and CMS guidelines. Small practices and in-house staff may not have the time or resources to keep this level of specialty expertise for the range of payers and services.
Compliance is not a set it and forget it process. When practices outsource medical billing services to a specialist partner, they get compliance oversight that tracks coding trends, proactively audits claims and identifies potential issues that may become payer problems. This ongoing compliance shield saves the practice at a fraction of the cost of in-house.
Reporting Transparency When You Outsource Medical Billing Services
A good outsource medical billing services provider offers daily, weekly and monthly reporting that allows practice administrators to see, in real time, collection performance, denial rates, aged accounts receivable and other metrics by payer. This type of financial information is not often made available from internal billing operations that are geared to high-volume processing as opposed to resource allocation.
AR Management Medical Billing: Stopping Revenue from Aging into Write-Offs
Medical billing AR management is the relentless working of all unpaid and underpaid claims until they’re settled. Unmanaged accounts receivable (AR) age past filing deadlines, miss payer appeals deadlines, and end up being written off as bad debt. As AR balances age, they become more and more difficult to recover.
Aging Buckets and Priority Tracking in AR Management Medical Billing
Medical billing AR management prioritizes claims based on age, payer and reason for denial to ensure the most valuable buckets of AR are given the highest priority. Older claims close to the timely filing deadline are prioritized over new claims that have just been denied, with plenty of time for resolution. In the absence of such prioritization, billing staff are forced to react to claims, and large claims are overlooked.
Payer-specific follow-up processes are crucial for AR management and medical billing. Each payer has its own appeal process, documentation requirements and response deadlines. An AR Management Medical Billing team that uses the same follow-up process for all payers loses appeals it would have won if it had used the correct follow-up process for each payer.
Root Cause Analysis in AR Management Medical Billing
Denial trends highlight issues that occur in hundreds of claims until the cause of the problem is found and fixed. Medical billing AR management that groups denial reasons by code, payer and provider makes the AR queue an opportunity for continuous improvement. Resolving the root cause of the problem will prevent the denial, and future AR volume will be reduced, and current AR collections will be increased.
Claim underpayments are often overlooked in AR management and medical billing. Underpayments are a result of a payer paying less than the contracted rate, and must be identified and appealed within the contract timeframe. Unless a practice audits payments against their fee schedule, they will be paid less than they are entitled to on some percentage of every claim.
Two Disciplines That Protect Every Dollar the Practice Earns
Medical billing outsourcing and strong AR management are two tools that can be used together to achieve the best revenue cycle results. Med Brigade brings expert knowledge in both, and provides the practices and the billing and collection capability to help them achieve their full potential.