Healthcare providers require medical billing and coding services to get paid for their procedures and treatments and any other medical care they provide their patients. Submitting medical bills, or claims, on time and getting them reimbursed without any delays is critical for successful revenue cycle management. Not only do staff need to follow-up with the payers, they also need to manage denials and work to reduce A/R days so that they stay profitable. However, effective medical coding and billing in-house can be tough as it requires great medical expertise and medical coding knowledge at another level entirely.
That is why, in recent times, many healthcare providers have sought out outsourcing partners. These partners provide timely medical billing and coding services and frees up physicians from having to deal with administrative tasks and follow-up. Outsourcing their billing and coding requirements also allows them to focus on providing quality medical care so that their core competencies remain a priority, not back-office administrative work.
Let’s explore what benefits healthcare providers can gain from outsourcing their medical billing and coding services to the professionals to see whether they may be right for you.
What Are Medical Billing and Coding Services?
Medical billing and coding are 2 tightly related aspects of the current healthcare industry. Both practices are required in the reimbursement cycle to ensure that healthcare providers are paid for the medical services they perform.
Medical coding is essentially a type of translation service. Coders take a doctor’s diagnosis and prescription and translate it accurately into numeric or alphanumeric code. Every injury, medical procedure, medical equipment, diagnosis, prescription, and treatment has its own corresponding code.
These codes are entered into the system so that insurance companies can read through them and determine which ones to reimburse in full, in part, or not at all. There are thousands upon thousands of codes for medical procedures, diagnoses, and outpatient treatments that medical coders need to be familiar with to do a good job of collecting reimbursements for the practice.
Medical billing is the next step in the RCM cycle. Medical billers take the information that the medical coders have put together and then create a bill for the insurance company, which is also called a ‘claim’. Claims can be generated on paper, but these days it is cutting-edge software that is used to ensure accuracy and timely reimbursements.
These claims are generated and then sent to the insurance carrier to be evaluated and further processed. The medical biller then evaluates the returned claim and determines how much of the bill the patient owes once insurance has been paid out. Billers also have the job of hiring collections agencies to follow-up with patients regarding their delinquent medical bills. All this is done to ensure that the healthcare provider is properly compensated for the medical care they provided.
In this way, medical billers act as an intermediary between patients, insurance carriers, and healthcare providers. While coders translate medical procedures into code, billers translate codes into financial reports and claims.
Types of Medical Billing and Coding Services
There are possibly thousands of different types of medical billing and coding services that healthcare providers require to keep their medical practice afloat. Some of these include:
- Physician Billing Services
- Medical Data Entry Services
- Patient Demographic Data Entry Services
- ICD-10 Coding Services
- CPT Coding Services
- Indexing Medical Records
- Credentialing and Enrolment Services
- EMS Billing Services
- DME Billing Services
- Claims Submission Services
- Appointment Scheduling Services
- Charge Entry Services
- Hospital Billing Services
- Accounts Receivables (A/R) Management Services
- Radiology Billing Services
- Dental Insurance Verification Services
- Payment Posting Services
- Medical Transcription Services
- Denial Management Services
- Revenue Cycle Management Services
Benefits of Outsourcing Medical Billing Services
- Reduced AR Days
- Greater Billing Compliance
- Improved Coding Accuracy
- Reduced Denials
- Higher Collection Rates
Outsourcing medical billing and coding services have a ton of benefits associated with them. Not only can healthcare providers benefit from greater HIPAA compliance for their practice, but they can also experience reduced AR days as a result. Outsourcing can also ensure that more claims are submitted with the highest levels of accuracy for maximum reimbursement.
Moreover, healthcare providers can look forward to benefiting from reduced denials and higher collection rates when they choose to work with outsourcing partners. To get a better idea of just how substantial these benefits can be to a healthcare provider, let’s explore them in greater detail.
Reduced AR Days
One of the measures of success for healthcare providers is Days in AR. AR days measure the total amount of time it takes to get paid for a submitted claim. According to different benchmarks, AR days for healthcare practices can range from 30 to 70 days. Most experts agree that having an average AR days of over 50 days indicates that there is a problem with medical collections or medical billing processes.
When healthcare providers outsource their medical billing services, they can look forward to benefiting from reduced AR days and therefore faster reimbursement. This is because outsourcing partners take measures to bill claims electronically instead of on paper, which cuts processing times by 13 days at least.
When AR days increase, cash flow is reduced as well. This means there is less money to hire the best staff, less capital available for expansion, and healthcare providers are less able to invest in the latest tools and technologies. Outsourcing ensures that you have low AR days so that you are better able to treat patients with high quality care.
Greater Billing Compliance
Healthcare compliance involves meeting regulations that are designed to prevent abuse and fraud by medical billers and coders. Rules need to be followed, whether that be regarding how to process and bill claims or regarding the importance of confidentiality when it comes handling healthcare information.
The Health Insurance Portability and Accountability Act (HIPAA) is what is often referred to when setting the bar for healthcare compliance. HIPAA states how various entities from clearinghouses to healthcare providers can disclose or use personal health data. Often, in-house medical billing teams struggle with meeting HIPAA compliance as it can be rather complex and requires a lot of time to process.
Because HIPAA compliance can be difficult to meet, healthcare providers often turn to outsourcing service providers for help. These outsourcing partners conduct risk and threat analysis on behalf of the healthcare providers so that they pass HIPAA audits without complications. Moreover, every medical bill is screened for compliance so that no violations arise that can result in corrective action for the provider. Outsourcing ensures that greater billing compliance is maintained at every stage of the billing process.
Improved Coding Accuracy
Under-coding and over-coding are 2 of the major medical coding issues that arise for healthcare providers. Both issues result in either greater claim rejections or smaller reimbursements for each submitted claim. Other coding issues include not coding to the highest level, failing to use updated code sets, and entering incorrect codes for a specific medical procedure. When medical coders fail to code to the highest level, many medical procedures and diagnoses are left unbilled.
When payers reimburse these claims, not enough money is collected to cover all the medical procedures performed, which results in losses for the healthcare provider. Similarly, when coders fail to use the most current code sets, the entire claim is automatically rejected and needs to be re-evaluated and resubmitted for reimbursement. Without coding accuracy, medical practices lose out on a lot of claims reimbursements and revenue.
Outsourcing your requirements to an offshore medical billing services provider can result in greater medical coding accuracy. Not only will outsourced coders code to the highest level, they will also ensure that only the most current code sets are used so that maximum reimbursements can be made.
Over-coding and under-coding will no longer be issues at your facility as all medical diagnosis and procedural codes will be entered accurately and fully. Moreover, medical coding errors will not be made as experts are employed to supervise the entire process. Improved reimbursement rates will also result in your healthcare facility bringing in greater revenues, which is highly advantageous for long term performance.
Reduced Denials
There are many reasons for claims denials when healthcare providers try to take care of their own medical billing services. From missing data or modifiers to highlighting the wrong plan code, there are a number of reasons that payers refuse to reimburse a claim and instead issue a claims denial. Claims can even be denied if they are not filed within a specific number of days or within their filing limit. Medical practices that do not have experts handling their medical coding often suffer from increasing claims denials due to errors or negligence.
When healthcare providers outsource medical billing and coding to offshore specialists, they are able to determine the reason for these claims denials. Denied claims can rather quickly add up to large A/R figures for the practice. Outsourced medical coders manage denied claims on a regular basis to identity key areas for improvement to ensure that a single problem doesn’t turn into a systemic one.
One claim denial is easily manageable, however, hundreds of denied claims can be overwhelming and lead to a complete loss of A/R. This, in turn, results in huge write-offs of uncollectible claims, which is money lost for the healthcare provider. Outsourcing medical billing services to offshore medical billing companies easily tackles the root cause of denials and results in increased cash flow instead.
Higher Collection Rates
The net collection rate is a good indicator of the health of your practice and shows you exactly how much money is coming in. Low collection rates are the result of extensive claims denials and a number of other factors. These denials may even come from not obtaining prior authorizations before administering the medical treatment or completing the medical procedure. Other reasons for low collection rates include not being reimbursed at the highest possible rate for that carrier, not implementing multiple claims scrubs for accuracy, and high revenue cycle times.
Outsourcing medical billing and coding to experts can improve your collection rates as they conduct fee schedule analysis to ensure that you are reimbursed at the highest rate possible for that particular carrier. They will also utilize multiple claims scrubs at different levels to ensure that all claims are submitted with accuracy, thus ensuring quick reimbursements are made. Finally, outsourcing partners will employ appropriate procedures and policies to help reduce your revenue cycle times and review all denials to get to their root cause.
Outsourced agents tend to have higher collection rates than clinics, hospitals, and physicians who try collections with their own limited RCM knowledge. Higher collection rates mean that you are able to bring in more revenue so that you can treat your patients with higher quality care and boost customer satisfaction long term.
Secondary Benefits of Outsourcing Medical Billing Services
Beyond the most critical benefits that outsourcing medical billing services provides, there are a number of secondary benefits as well. These include everything from lower operational costs and faster turnaround times to improved business continuity and higher quality medical coders and billers. To understand just how a healthcare provider can benefit from outsourcing in other ways, let’s take a brief glance at them now.
Improved Business Continuity
Healthcare providers often are at a loss when their medical billing and coding specialists fall sick or leave the practice on short notice. Medical coders are especially difficult to come by given how much training and expertise they need to have in medical coding before they can be hired.
Finding medical coders who are skilled in applying the right medical codes, using the correct modifiers, and know industry regulations and HIPAA compliance guidelines inside out are a rare breed. That is why keeping a medical practice’s RCM processes up and running is no easy feat. When such individuals leave or are out of service for an extended period of time, the medical practice suffers.
Outsourcing medical billing and coding to the experts, however, can fix this problem. This is because outsourced coders come with years of domain expertise and they specialize in coding to the highest levels for maximum reimbursements. With outsourcing, these coding experts can be brought onboard almost immediately from a large pool of talent.
If a medical practice can hire outsourced experts in days, this puts an end to business disruptions and leaves the practice with improved business continuity no matter what happens. Also, the fact that more resources can be onboarded at any time to handle any business volumes means that healthcare providers will never again be at a loss for talent.
Highly Qualified Subject Matter Experts
Medical coding and billing has become increasingly complex and requires a greater level of expertise to obtain maximum reimbursements from insurance carriers and patients alike. Often healthcare providers cannot afford to hire in-house coders and billers of a higher caliber as they are difficult to find and retain. In-house coders and billers may process hundreds of claims every month, while medical billing companies process thousands of different claims across multiple specialties. Because medical coding and billing is a full-time job, it cannot be entrusted to just any staff, but this is often a reality at many healthcare facilities across the nation.
Outsourcing companies on the other hand often have massive pools of talent available at any moment to draw from to carry out the tasks efficiently for a healthcare provider. Outsourced medical coders are highly qualified subject matter experts who have years of experience in only coding and are well-trained with the latest coding practices and regulations.
They are specialists in the domain of medical coding and know what tactics to use to ensure maximum reimbursements and optimal cash flow for the healthcare provider. When you outsource medical billing and coding services you can rest assured that you will benefit from a wider range of expertise and knowledge than if you were to source the talent yourself in-house.
Medical coding and billing services are not simple in any way. That is why more and more healthcare providers are turning to outsourcing partners to help them drive greater cash flow and benefit from maximum reimbursements. Although there are hundreds of benefits to outsourcing your medical billing and coding requirements, the most important include reduced denials, higher collection rates, and improved coding accuracy. Other compelling benefits also include reduced AR days and better compliance with industry-wide regulations and protocols.
While hiring in-house staff is great if you want to process claims at your own leisure, you can trust the professionals to get the job done with greater accuracy, for less money, in less time, and with fewer complications arising. Turn to outsourced medical billing and coding companies if you want to see trends in the industry long before other segments so that you can adapt to the times with greater agility and beat out your competition.
Who We Are and Why Trust Our Domain Knowledge and Expertise?
This article is brought to you by OutSourceRCM, an enterprise-grade solution provider for all your end-to-end revenue cycle management requirements. Over the 10 years we have been in business developing RCM solutions for our clients, we have witnessed massive transformations in the healthcare sector. Our extended experience in this domain has given us insights into how to help healthcare providers plug different sources of revenue leakage and address costly inefficiencies in their existing processes. Our medical billing and coding services meet some of the highest quality standards in the industry and keep our clients far ahead of their competition. Our vast pool of highly qualified talent has the expertise they need to substantially boost cash flow and gain maximum reimbursements for healthcare providers across the nation.
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