Medical Billing Outsourcing Services: Solving the Staffing Problem Nobody Talks About

The in-house billing seems like it would be easier to do on a piece of paper. Hire one and they learn your system and claims are submitted. In reality it is not that simple.

It takes time and money to hire a medical biller who is experienced. After hiring, they must learn how you use your EHR, your payer mix, and how you document your practice. Then, there's continuing education, as payer rules, such as prior authorization and coding changes, evolve constantly. But if that person walks out, you're back to square one with claims that have been "partway done.

Then tack on software licensing, compliance requirements and the management burden of running a billing department, and the in-house solution suddenly becomes much more expensive than it originally seemed.

Medical billing outsourcing services come into the picture here. You are not limited to just one or two people with the entire billing responsibility; rather you have an entire team that has cross-trained, with built-in redundancy, between coding, claims, and follow up.

What is meant by “good outsourcing” and what it looks like.

Outsourcing does not result in a lack of visibility of the billing process for your company. When done right it means acquiring more of it. Here are the components of a well-managed engagement:

Getting answers to coverage, copay and authorization details before the appointment, and not after it's been denied weeks later.

With CPT, ICD-10, and HCPCS coding, certified coders are able to assign codes that correspond to documentation and that meet the expectations of the payers, thereby eliminating the need for back-and-forth communication, which slows down payment.

Claims are reviewed for error prior to return, not upon return. This is the most important factor in a practice's speed of payment in many cases.

No payment is missed, every one gets recorded and is matched to what was billed.

Quickly denied claims are quickly investigated, corrected, and resubmitted, rather than left untouched, as there was no one to have the bandwidth to deal with them.

Claims that have been reported for 30 days, 60 days, or 90 days are given regular attention and not just a birds-eye view every now and then when someone recalls.

Its aim is not to pass the baton and hope for the best, but to have a team on board with a focus of keeping this process going every single day.

Why EHR Compatibility is more than what people think.

When the question of outsourcing comes up, one thing that's not always considered is whether or not the billing staff are part of your current system, or if it involves switching to a new one.

Moving platforms simply to provide a billing vendor is more of a hassle than it's worth. Hired Billing Support instead works in your practice's existing EHR, such as Athenahealth, eClinicalWorks, Kareo, AdvancedMD, DrChrono, NextGen, Epic or Cerner, and no more re-training your front desk or re-mapping your workflows.

This is important because billing isn't done in a vacuum. It involves scheduling, documentation and patient interaction. A billing partner that integrates with your existing solution creates very little friction as compared to one that requires you to build around them.

Statements of "improved efficiency" are better illustrated by numbers. Those that transitioned from general medical billing outsourcing to special services have experienced an average accounts receivable period of 47 days, which has been reduced to 21.5 days, a significant decrease in collection time. The far fewer rejected claims that are sent back through the system is reflected in the first pass clean claim rates around 98%.

One 4 physician primary care practice was able to recover more than $112,000 in claim denials, and over 30% of aging receivables, within 90 days of moving to 100% full outsourced support. Not a marginal improvement, that's money the practice had earned before someone did the job right.

Anyone who has been burnt by vendors who bill a flat fee for their work will naturally have some doubts about outsourcing costs.

The majority of dependable medical billing out-sourcing companies, such as the model utilized by Hired Billing Support, charge a percentage of genuine collections — usually 3–7% — instead of a hard and fast rate that doesn't rely on success. That gives the billing partner an incentive to get paid for services rendered, as opposed to an incentive to bill and wait for payment.

When it comes to hiring, training and retaining an equivalent in-house team (salaries, benefits, software, turnover, etc.), the total cost of outsourced models is generally 50-60% less without sacrificing follow-up or reporting quality.

Not all billing partners are created equal and they can vary in transparency and expertise. Some questions will save lots of trouble in the future:

Is the team installed within your existing EHR or do you need to change your health IT systems?

Does pricing depend on actual collections or is there a flat fee regardless of whether they are collected?

Do they offer actual performance metrics – AR days, denial rates, clean-claim percentages?

Do they have the proper data security measures and are they HIPAA compliant?

Will the partnership fall apart if it doesn't work out, or will you have to suffer the long-term effects of a contract?

Built on clear answers to each of these, Hired Billing Support is not tied to any specific EHR and handles HIPAA-compliant data with encryption, reports transparently, has no long-term contracts, and bases their pricing on collections, not claim volume.

Medical billing outsourcing is not necessarily a replacement for employees; it is a way to eliminate the weakness from relying on a single or two in-house staff for the functioning of an entire revenue stream. When verification, coding, claims and follow up are managed within a consistent and trained team, practices never lose money due to staff turnover, missed authorization, or denials that were never reviewed again.

When it comes to billing gaps, from employees departing your practice to claims being longstanding and simply slipping through the cracks, it may be time to call it quits on the old way of putting out fires and hiring the right team to solve the problem every time. It's not about speeding paperwork up. It's ensuring that the money earned in your practice actually ends up in your bank account.