The article aims to discuss how outsourcing medical billing helps in improving revenue.
In the United States, the healthcare industry could have saved $16.3 billion in 2020, or 42% of the $39 billion spent on administrative transactions.
If you’re a healthcare provider, your main focus is to provide the best possible care for your patients and at the same time improve revenue.
Medical billing is part of the administrative side of a practice that is a highly transactional function that can be outsourced.
Outsourcing the services of a billing company to handle your medical billing operations can help lessen costs associated with this aspect of your business and free up more time on administrative functions to focus on patient care.
What is Medical Billing Outsourcing?
Medical Billing outsourcing is the practice of healthcare organizations outsourcing non-core business functions, in this case medical billing, to third-party service providers.
Medical billing outsourcing companies offer a range of services, from setting up an in-house collection center to outsourcing the entire process to an external provider. Outsourcing medical billing can bring several benefits to a practice, such as having experts and software to make the processes more efficient and cost-effective, and helping improve the entire revenue cycle.
Practices that outsource their billing had a higher percentage of claims paid on the first submission (80%) than practices that handle their own billing (68%).
Outsourcing billing can lead to more efficient and effective billing practices, resulting in increased revenue for the practice.
Read more for some ways outsourcing medical billing can help improve revenue.
For one, claims are submitted accurately and timely, denied claims are reduced, and the percentage of claims paid are improved, with the help of outsourced billing professionals who have the necessary expertise and knowledge on complex insurance and billing systems.
Insurance companies may require certain documentation or coding requirements for services to be reimbursed. Another way medical billing outsourcing providers can help improve the overall revenue cycle is by outsourcing the services of trained billing professionals to ensure that claims are submitted with the appropriate documentation and coding.
Outsourcing medical billing can help reduce billing errors, denials and underpayments. Billing professionals can review claims and payments to make sure that the practice is receiving the correct amount of reimbursement for services rendered. This can help to identify underpayments and missed opportunities for reimbursement, resulting in increased revenue for the practice.
Outsourcing medical billing can also help reduce the amount of time and resources spent on collections, making sure the process is free from errors.
Medical codes are important in the medical billing process. Incorrect processing of medical claims are usually caused by errors in medical coding such as incorrect patient information, duplicate charges, incorrect coding used, upcoding, or unbundling. Examples of medical codes are CPT, HCPCS, ICD-10-CM, and ASA, APC and DRG codes which must be determined and processed correctly to ensure the patient is properly billed for the corresponding treatment.
Medical Billing professionals can also follow up on outstanding claims and ensure that the practice is receiving timely payment for services rendered. This can help reduce the number of outstanding balances and improve cash flow for the practice.
Medical billing outsourcing lets you work with billing professionals that have the right technical expertise and experience in cash flow and billing management. Outsourced billers can process, document, review outstanding billing payments for you. They make sure payments owed to the practice are properly paid or collected on time. They provide necessary follow-ups on payment collections by reaching out and making the necessary follow-ups via inbound calling.
Other Healthcare Roles you can Outsource
Aside from outsourcing medical billing, practices can also outsource the services of staff to handle functions such as retrieving and monitoring data and charts, maintenance of security, and patient care.
Virtual Nurse: Virtual Nurses are qualified registered nurses who are well-trained professional able to give the best nursing care with little supervision They work with a variety of patients and provide direct nursing care along with physical or psychological support when required.
Virtual Nurses are responsible for patient assessment, as well as planning of care and subsequent recovery. They are also able to work closely with health care practitioners to ensure the recovery of patients.
Their duty includes tasks like creating and maintaining accurate patient records, administering medication and monitoring for side effects, recording vital signs, and reporting symptoms and changes in patient conditions.
Outsourced Chart Retrieval Specialists: Outsourced Chart Retrieval Specialists are responsible in retrieving medical records and patient information from healthcare facilities for use in insurance claims processing, medical research, and other purposes. Outsourced Chart Retrieval Specialists work under the direction of a medical records manager or healthcare administrator to locate and retrieve medical records from healthcare facilities.
Their functions include requesting medical records and patient information from healthcare facilities, including hospitals, clinics, and physician offices, tracking record requests, managing, reviewing and ensuring that requested records are received on time, while meeting legal and regulatory requirements related to the retrieval and handling of medical records.
Data Curator: Data Curators are responsible for collecting, organizing, and managing large sets of data, including creating data sets, defining data schemas, and creating data models, and ensuring that data is accurate, complete, and accessible to authorized users.
Responsibilities of an outsourced Data Curator includes implementing data standards, collecting data from various sources, organizing it, then preparing it for analysis and review to make sure data is accurate and complete.
Remote Information and Patient Data Security Manager: An outsourced Remote Information and Patient Data Security Manager is responsible for ensuring that security and integrity protocols and procedures are integrated into the healthcare organization’s patient data and operations. This involves working with a team of professionals to develop and implement security measures that protect sensitive patient information from cyber threats and data breaches.
Outsourced Remote Information and Patient Data Security Managers develop and implement security protocols that protect patient data and conduct regular risk assessments to identify potential vulnerabilities in the healthcare organization’s information systems and infrastructure and make sure that these protocols comply with regulatory requirements and industry standards such as HIPAA, GDPR, and other relevant data protection laws.
Overall, the remote information and patient data security manager plays a critical role in protecting the privacy and security of patient data in a healthcare organization.
Conclusion
Outsourcing medical billing can help practices increase revenue by reducing the number of denied claims, identifying potential billing errors and underpayments, and improving collections processes. By outsourcing the billing process, practices can focus on providing high-quality patient care while still being able to improve revenue.
Find out the optimal time to transition to outsourced billing for maximum revenue impact. Visit our blog post when should I outsource medical billing? to complement your understanding of how this move can enhance your revenue generation.
Boost your revenue with the right partner: delve into our blog post showcasing the top 10 medical billing outsourcing companies for 2022, and find the best match for your financial goals.
Outsource Healthcare services to Connext today.
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References:
2020 CAQH Index. Closing the Gap: The Industry Continues to Improve, but Opportunities for Automation Remain. www.caqh.org. Council for Affordable Quality Healthcare, Inc. (CAQH).
Andrew Cantor. “Revenue Cycle Management Optimization and Technology Implementation in a Mid-Sized Primary Care Practice”. Journal of Healthcare Information Management. 2018.
Common Medical Billing Errors. https://www.arthritis.org/health-wellness/treatment/insurance-management/toolkit/common-medical-billing-errors. Arthritis Foundation.
