Promoted

Brahmi Extract

23 Jul 2024

Share Market Courses in Lucknow – Stock Trading Classes

11 Oct 2024

Described as an ambitious and genre-defying project

10 Oct 2024

微笑項鍊 Tiffany：優雅與間約的象徵

12 Oct 2024

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for the services rendered to patients. It involves verifying insurance eligibility, getting authorization for services, collecting copays and deductibles, submitting accurate claims, handling denials and appeals, and depositing payments. With tight procedures and compliance requirements, medical billing is a complex and time-consuming process that requires dedicated staff and expensive software systems and tools.

Reasons for Medical Billing Outsourcing
Given the intricacies of medical billing and coding, most healthcare providers face mounting pressure to reduce expenses and allocate resources to direct patient care services. Outsourcing non-core functions like billing allows providers to focus on their clinical expertise while leveraging the economies of scale of billing specialists. Some of the key drivers for outsourcing medical billing include:

- Cost savings: Billing companies can perform billing services at a lower cost by absorbing fixed costs over a large volume of clients. They also offer flexibility to scale up or down billing staff as needed.

- Access to advanced technology: Billing vendors have robust IT infrastructures and billing software tailored for healthcare that providers may not be able to afford on their own. This improves billing accuracy, efficiency, and compliance.

- Staffing challenges: Finding and retaining qualified billing staff requires significant investment for training, certification, and competitive pay. Outsourcing eliminates these issues and provides access to skilled resources.

- Compliance expertise: Billing vendors have teams of expert coders, billers, and compliance officers continuously trained in insurance and regulatory changes to ensure full compliance. Managing compliance in-house is challenging.

- Focus on patient care: Outsourcing non-clinical functions frees up provider resources and capital to invest in direct patient services and clinical growth priorities like new specialties or locations.

Choosing a Reputable Billing Vendor
With many regional and national billing companies in the market, healthcare providers must conduct thorough due diligence to choose a partner aligned with their organizational needs and values. Some things to evaluate include:

- Experience in provider’s specialty: Billing vendors have varying expertise in different specialties like primary care, surgery, therapy etc. Choose one experienced in your specialty/specialties.

- Technology platform: Evaluate the billing software, tools, data security, backups, upgrades, etc. Ease of use and integration with your EHR is important.

- Pricing models: Pricing varies greatly. Understand completely per claim, monthly, annual or percentage of collection models to compare true costs. Get multi-year pricing.

- Turnaround time: Ask expectations and guarantees for claim submission, payment receipt, denials management, appeals, and reporting. Faster is better for cash flow.

- Value-added services: Consider vendors also offering credentialing, referrals, patient statements etc. reducing your vendor universe.

- Regulatory compliance: Check billing vendor’s compliance programs, audits, and certifications like HIPAA. Ask for client references and compliance records.

- Client support: Inquire about onboarding, training, dedicated account managers, escalation protocols and helpdesk/technical support availability.

Key is finding a partner focused on your success with competitive pricing, expertise and excellent client service for a long-term collaborative relationship. Signing a detailed service agreement protecting both parties’ obligations is also recommended. With right due diligence, outsourcing can streamline billing and improve a practice’s financial productivity.

Evaluating Medical Billing Outsourcing Vendor Performance
After on boarding with a billing company, it is important for healthcare providers to closely monitor billing vendor performance to ensure the outsourcing achieves desired objectives. Some of the key performance metrics to track include:

- Claim submission rate: Ratio of clean claims submitted within timely filing limits to total bills generated. Industry standard over 95%.

- Payment rate: Percentage of submitted claims that get paid. Over industry average indicates accurate billing.

- Denial rate: Proportion of denied claims to total submitted. A sustained high rate means lower collection rate or compliance issues.

- Days in Accounts Receivable (DAR): Average number of days from date of service to collection. Industry DAR is 45-60 days.

- Accounts Receivable (A/R) aging: Monthly reports show percentage of A/R in 0-30, 30-60, 60-90, 90-120 and over 120 day periods.

- Biweekly or monthly reporting on metrics, accounts, aging and financials.

- Customer support response rate: Percentage of issues needing research addressed within 24-48 hours.

- Annual audits of samples of claims for accuracy.

- Client retention/satisfaction surveys.

Comparing metrics to peers, historical performance and timely issue resolution allows evaluating vendor quality and value. Annual vendor contract re-negotiation keeps them accountable. With diligent selection and oversight, billing outsourcing helps maximize practice revenues.