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Pros & Cons to Outsourcing Your Medical Billing

The business of running an independent medical practice becomes more complex with every passing year. There are new regulations, coding updates, changing payer rules and performance measures that can significantly affect reimbursement. Organizations put their cash flow and revenue at risk when they are slow to keep up with the updates necessary to keep their revenue cycle running smoothly.

For many practices, the administrative burden of processing their medical billing becomes overwhelming. They find the time and money devoted to claims management grows every year, and the challenges to get paid are a source of labor-drain and frustration.

As such, many decide to outsource medical billing to simplify their administrative process and get the highest return of investment of their revenue cycle management dollars.

Once you outsource medical billing you may come across several questions with regard to this new process. We’ve worked with medical practices of all specialties and sizes. Over the years we noticed there are questions asked by practically every organization that is evaluating a new billing company or considering outsourcing medical billing functions for the first time. We’ve outlined a few of these common questions and concerns below.

Question: How do we know our revenue will benefit from a change?

Big picture benefit: If your practice is struggling under the weight of medical claim processing and management, the writing is on the wall – if you fail to act, you will see a decrease in reimbursement. Partnering with a billing company allows you to benefit from the accumulated experience and knowledge gained by working with practices similar to yours. This is particularly true if you are in a specialized practice – such as radiology, pathology or anesthesiology.

Efficient denial management is also a huge plus when using a medical billing company. The billing partner you choose will only get paid if you do – which increases the incentive for the billing company to pursue every dollar you are owed.

Question: I am afraid to lose control over my billing. How will I know what is going on?

Big picture benefit: Effective medical billing companies will hold themselves accountable for results and produce financial reports on (at least) a monthly basis – creating structure in measuring the performance of billing operations. Many practices that convert to outside billing after having an internal department are surprised by the level of reporting produced by their billing company every month. Reporting is often customizable to the needs of the practice and is enabled by a software platform that can provide real time metrics.

In-house billing departments that have grown organically over time sometimes don’t absorb the best practices of the industry. Since they only have the time and resources to concentrate on the activities of the moment, they can’t look outward for new strategies and are not guided by billing metrics in making operational changes. Revenue cycle management companies have a vested interest in continual improvements to maximize cash flow and reimbursements.

Question: How will the new company ensure our office workflows will not be disrupted and our information preserved during the transition?

Big picture benefit: Most revenue cycle management companies have transition departments to ensure the flow of information runs smoothly, all visits are accounted for, and subsequent claims created. Since your reimbursement is directly tied to their payment, it is in everyone’s best interest to ensure all claims are generated and submitted in a timely fashion.

Another benefit of having to outsource medical billing is that staff in the office can now concentrate solely on the clinical aspects of patient care and the overall experience your practice provides. Time can be devoted to ensuring that quality of care and patient satisfaction benchmarks are met, which is necessary to keep your revenue moving in a positive direction.

Question: Will they treat my patients with the respect they deserve?

Big picture benefit: Healthcare organizations are correct to be concerned about patient satisfaction. Patients are responsible for an increasing percentage of overall reimbursement and now have a consumer mindset which is a change for the industry.

Reputable billing companies have well-trained staff who are experts at dealing with patient questions and concerns. Every office, both inside and outside healthcare, knows that it is impossible to satisfy each consumer every time. However, billing companies often have tools such as recorded calls that help ensure every patient interaction is handled appropriately and politely.

Question: How do I know outsourcing will work for me financially?

Big picture benefit: Collecting your reimbursement is expensive – a well-run billing department requires technology, space, constant training and experienced personnel. There was a time when offices could make do with medical billers who were little more than data processors. That time is over because of the increasing complexity and ever-changing nature of our healthcare system.

According to Indeed, the average billing specialist stays with an organization for 1 – 3 years. For most medical practices, that means they are continually incurring costs to hire and train new employees. The average biller costs $27/hour,2 so the money spent hiring and retaining the labor necessary for revenue cycle management adds up fast. Labor costs along with billing performance are undoubtedly the most substantial factors cited when the decision is made to outsource medical billing.

To make the best decision for the financial health of your organization, it is necessary to take a step back and make an objective evaluation of your practice’s billing operations. From there, you will be able to determine the next steps to making the best decision for your bottom line. Make sure that your decisions take into account the billing metrics that guide your practice.1

2 The hourly rate estimate reflects data from salary.com and the Intuit QuickBooks employee cost calculator.


Medusind improves the financial health of medical practices, groups, and hospitals with industry-leading medical billing expertise and technology.
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posted by OBarros
posted in Healthcare Management,Medical Billing
posted date Apr 2019