The healthcare industry is a chaotic, headache-inducing landscape that complicates billing for medical services. With ever-changing regulations and capricious insurance requirements, it can be difficult for medical practices to stay competitive. But outsourcing medical billing services can help, as they are provided by third-party companies specializing in the administrative tasks of medical billing. These include everything from coding and submitting claims to collecting payments and managing accounts receivable.

Benefits of Outsource Medical Billing Services

When considering outsourcing their medical billing, administrators are looking to:

• Increase accuracy: Outsource medical billing companies have access to the latest coding and billing software. Their staff members are adept with the newest reimbursement rules and regulations, so they understand your medical niche and will focus on the codes and procedures relevant to your practice.
• Enhance efficiency: Medical administrators are often overwhelmed. By outsourcing, healthcare providers can prioritize efficiency, thus reducing administrative burdens. Dedicated off-site staff members free up your in-house personnel for more critical tasks. A key factor of revenue management companies is specialized software and processes that streamline billing procedures and minimize errors.
• Improve cash flow: A medical practice depends on steady cash flow. An essential benefit of third-party companies is revenue cycle management, which helps regulate payment collections by following up on outstanding claims and automatically appealing denials. This attention to detail improves cash flow, reducing time spent chasing down payments.
• Increase peace of mind: Constantly waking up in the middle of the night wondering if you processed that last batch of claims can be stressful. Outsourcing your medical billing provides office staff with assurance and reduces administrative stress. An improved working environment enables offices to focus on providing quality care, developing new services, or expanding the practice.
• Decrease technological expense: Keeping up with technology can strain your annual budget. However, billing companies invest heavily in technology to stay ahead of industry trends and regulations. Outsourcing medical billing services can provide healthcare providers access to the newest billing technology and software without the deep investment.

Drawbacks of Outsource Medical Billing Services

Despite all the possible benefits, even for small and single-practitioner offices, outsourcing medical billing does have a few potential drawbacks.

• Overall cost: It’s typically inexpensive to outsource medical billing services. But numerous fees can be hidden within any contract. Your medical practice may incur per-claim billing, setup, and onboarding fees or additional costs for practice-specific technology. Some companies may charge additional fees for late payments, claim denials, or other unexpected expenses.
• Loss of control: Losing control over the billing process can be a significant hurdle for many administrators. Without complete transparency, many healthcare providers feel disconnected from the billing process, as they don’t know how their billing is handled. Additionally, off-site billing staff may not be as personally invested in the practice’s success as in-house staff.
• Miscommunication: Unsurprisingly, outsourcing medical billing services can lead to communication issues between the practice administrators and the billing company. Another concern involves billing company staff turnover. When account representatives leave their positions, the quality of service may be affected. These factors may delay processing claims and resolving billing issues, negatively impacting cash flow and patient satisfaction.
• Security concerns: Moving billing practices off-site can introduce security concerns, especially when dealing with HIPAA-protected patient information. As ultimately responsible for their practice’s information, healthcare providers must ensure that an outsource billing company complies with industry standards and regulations to avoid potential data breaches.
• Lack of customization: Highly specialized medical offices have specific challenges, and outsourcing companies may be unable to customize their services to meet these needs.

With all these pros and cons, should you opt for third-party billing? Numerous factors will affect your decision, such as your practice’s size, the available budget, and personal comfort level with outsourcing. When considering outsourcing medical billing and compliance, it is essential to research options so you will choose a reputable company.

What to Consider When Outsourcing Medical Billing

When researching a billing service, be sure to consider the following:

• Practice size: If you have a small practice with limited claims, you may not need to outsource medical billing. However, practices with high claims volumes may benefit from the flexibility and cost-effectiveness of third-party billing.
• Available budget: Most outsource medical billing services typically charge per claim, though some companies offer service packages or charge monthly fees. Outsourcing costs vary depending on claims volume and the chosen service options. Consequently, budgetary restrictions may affect an administrator’s final decision.
• Potential for errors: Unique medical niches often have issues when outsourcing medical billing. These services can introduce potential mistakes, especially if the billing company is unfamiliar with the practice-specific procedures and policies. Whether human or technological, errors lead to denied claims, delayed payments, and potential negative patient interactions.
• Need for transparency: Migrating billing practices off-site doesn’t necessarily mean abdicating involvement entirely. Work with your billing firm, advising them of service changes or compliance issues. Scheduling a periodic review of the billing services can help alleviate concerns. Even a cursory glance at billing reports can catch potentially costly mistakes.
• Overall comfort level: Some healthcare providers are more comfortable outsourcing medical billing than others. If giving up control of the billing process causes distress, consider keeping it in-house.

Outsourcing medical billing services can benefit healthcare providers significantly, including cost savings, increased efficiency, improved cash flow, and access to technology. However, it has a few drawbacks, including loss of control, potential errors, communication issues, and security concerns. So, should you outsource medical billing services? That depends on your practice’s specific needs and goals. You must carefully consider the pros and cons and weigh your options before deciding.

Outsourcing your medical billing to StarkBilling eliminates the time-consuming process of providing continuing education to staff in order to keep up with insurance and HIPAA regulations. Contact us today.