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8 common myths about outsourcing Revenue Cycle operations and Medical Billing

What is Medical Billing?

Medical billing is a complex and integral part of today’s healthcare system. It is a tedious process of submitting and following up on claims with health insurance companies to receive payment for services performed by the healthcare provider. To ensure that the practices receive reimbursement for the services provided; is the responsibility of the medical biller in the healthcare facility. Therefore, it is important to have knowledgeable biller who can optimize revenue for the practice.

How to bill medical services?

Entering the medical clinic may give an impression of having one-on-one interaction with the provider, but in reality, it is a complex system that involves numerous information and payment. The process of medical billing revolves around patients, providers and insurance companies. 

It is very vital to collect information about the patient and their procedures using proper diagnosis codes and documenting it using ICD codes, before compiling all into a bill and sending it to the insurance company. The claims should be compliant, factual and in the right format. 

The medical biller must be in constant communication with the insurance payors, clearinghouses, providers, and patients. They even have to clarify and follow-up with different types of insurance companies. They not only have to notify providers but have to keep patients in the loop too, regarding their medical bills – this is called EOB (Explanation of Benefits). Thus, medical billers have to be thorough with the medical billing process, not giving any room for glitches.

What are medical claims?

The claim is created when medical billing is directly overlapping with medical coding. Medical billers have to be experts in the diagnosis of the codes used by medical practitioners and use them to create claims. CPT – current procedure Terminology or HCPCS – Healthcare Common Procedure Coding System tells the payor what service was performed by the healthcare provider. Then the biller adds the information about the patient’s visit along with the cost of the procedure/procedures performed to the claim.
The medical biller also has to work daily with patients’ medical records, while presenting a bill at the end of the services. The bill is created by looking at the remaining balance (if any), then adding the cost of the procedure or service to that balance, deducting the amount covered by the insurance, and finally factoring the patient’s copay or deductible. There is frequent work with insurance clearinghouses to streamline this process. A clean claim contains no errors, with fast processing, saving time and ensuring the reimbursements. 

Is in-house medical billing more beneficial?

Some practices appreciate having control of their monetary operations by having an in-house billing expert. The practice would have to make an investment in the billing software and also train the medical billers. In case any issues arise during the medical billing, there is easy accessibility. 

But the practices also need to consider high salaries for the in-house billers, purchasing the technology along with its implementation and maintenance. There can be room for embezzlement if the billing operators neglect forms, discarded superbills and denied claims. The incoming revenues can also be affected if the employee is on leave of absence, vacation, or quits. To avoid such downfalls, it is sometimes best to consider outsourcing.

Why opt for Outsourcing the Medical Billing process?

Handling medical billings procedure is as important as handling patients, even though it may appear to be a mundane task. Accurate management of the insurance claim is the single most important source of revenue for the practice. Mistakes are likely to occur when novices are handling the responsibilities related to medical billings, where such a situation demands the need for a solution that ensures a flawless workflow of the billing process. Many leading medical practitioners have trusted iPatientCare medical billing services, which has overall proved to be exceptionally beneficial. But still, there are some inhibitions that some healthcare practitioners possess, regarding outsourcing their medical billings.

Related Article: Healthcare Revenue Cycle Management: Is it cheaper to embed it than it is to outsource it?

Aside from security and quality concerns, the biggest misconception about medical billing outsourcing is its limitations and scope. People judge outsourcing based on the myths they have heard from other people. These misconceptions and myths can make or break decisions to outsource, and uninformed decision-makers might just lose the opportunities they can get from outsourcing.

Let’s take a look at 8 revenue cycle management (RCM) myths we commonly hear and see how they are impacting medical practices:

1. Patients are only a small portion of the payer mix.
Patients are now the third-largest payers, burdened with increasing financial responsibility for their healthcare costs. Practices and hospitals, therefore, need to place greater emphasis on providing accurate patient estimations before delivering care and also collecting fees upfront.

2. Some believe that medical coding and billing is mostly limited to data entry.
Medical billing is much more than doing data entry. A medical coder needs to first read and understand medical records or notes; then they must determine what information is relevant and finally translate that information into codes.

3. When you outsource, you may lose control of your practice’s revenue process.
Medical billing companies provide the service of managing the revenue generation and reconciliation. The outsourcing companies tend to only look over this specific task of the practice and report it accordingly. They ensure that the practice is well informed about all the happenings and also strive to provide the greatest value.

4. It is more expensive to outsource.
Although it can seem like paying an external medical billing provider will cost you more money, it can boost your total revenues significantly. By improving the collections process, outsourcing vendors like iPatientCare can increase total collections for many different practices. Expert medical billing vendors typically save their client’s money by turning their organization’s revenue cycle into a well-oiled machine.

5. You won’t get returns on your investments in RCM technology.
With cloud-based technology, outsourcing RCM can offer comprehensive benefits by integrating financials with patient portals, offering electronic payment options, sending electronic statements and reminders, and even enabling patients to pre-pay for services, the back-office can be freed from recurring administration activities. Leading vendors who are certified in medical billing practices can reduce days in A/R and lower practice’s claim rejection rates to the point where they can outpace industry averages. All of this results in stronger reimbursement and strengthening cash flow that makes providers quantifiable ROI on the technology and services invested.

6. Outsourcing only helps in cutting operational costs.
Cost reduction is one of the benefits of outsourcing, not the only significant case to consider. The value and efficiency delivered by the medical billing companies’ results help in improving and accelerating other management departments.

7. Only big practices and hospitals can afford to outsource.
Although medical billing vendors are more attracted to bigger clients, they are not closing their doors to small businesses. Small and medium-sized practices are the top customers of revenue cycle management vendors. For most practices irrespective of their specialties, outsourcing their revenue cycle operations is a common practice.

8. Many are scared of outsourcing because it reveals confidential information to third-party service providers
At first glance, many would assume that medical billing vendors can see through the practice’s entire activities. The security and safety of a company’s data is the top priority of revenue cycle management vendors. If they mismanage the data of their clients, practices will lose confidence in the outsourcing vendors and might affect their business in the long run.

Moving beyond the Myths

The billing professionals need to be familiar with numerous insurance companies and be able to interpret all the right codes to have a flawless claim. Even the established and well-managed practices cannot excel at everything at all times. Outsourcing revenue cycle management allows the practice to focus on its patients and optimize patient engagement.

It is better to outsource to the vendor who is more experienced and has expertise and resources, rather than stretching the capabilities of your staff and attempting to keep all processes in-house. Outsourcing helps develop a strong line of communication between the experts and the practice, and defining clear processes tailored to the needs of the practice.

Outsourcing consents practices and hospitals to gain more control, and devote more time on core issues of their patients’needs. It reduces denied claims and other unexpected costs, thus increasing profits. If opting for the right choice – choosing to outsource your medical billing services; your practice will have a competitive edge in the marketplace.
These experts help practices and hospitals diminish any existing denied claims and avoid them completely in future. The outsourcing companies are composed of dedicated specialized personnel who efficiently submits the claims and makes follow-ups on those claims, till the final reimbursements; thus conducting effective denial management on regular basis.

As mentioned above, outsourcing this service will reduce costs and increase profits without compromise. Businesses are having to work cannier than ever to stay competitive and grow with the rapid increase in globalization over the last decade, coupled with the tremendous advancements in information technology. By partnering with a trustworthy vendor, the practice can improve efficiency and service quality, at the same time making more profit than by possessing an in-house billing system.

To learn more about how iPatientCare revenue cycle management solutions can benefit you, please contact our medical billing experts by clicking here.


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