MISCONCEPTIONS ALERT: OUTSOURCING MEDICAL BILLING AND CODING
Apr 28, 2019 23:00
Per the Medical Billing Outsourcing market, which is a global study of the scope of healthcare organizations outsourcing their medical billing and coding services to an independent company, a significant CAGR can be expected from 2018-2026, with 2017 being its base year. The reports suggest that the medical billing outsourcing market is expected to grow at the rate of 11.4% throughout the forecast period and may become a US $ 19.3 million industry by 2026.
With CMS implementing mandatory value-based care, introducing healthcare transparency, evolving bundled payment, CMS and HHS are regulating healthcare organization policies to make medical treatment and care affordable and qualitative for the patient, simultaneously ensuring there is less burden on the physician.
This rapidly evolving healthcare landscape is providing operators, medical practitioners, staff with less time to divide between delivering quality treatment and care to the patients, and checking how the financial aspect of the practice is doing. The increasing intricacies and the hassle of having to deal with it, that too without guarantee of not making any mistakes have led healthcare practice to prefer outsourced medical billing service over stressing their in-house.
A lot of healthcare practices have moved to outsource their entire revenue cycle to a credible medical billing service voluntarily, upon cognizance of benefits.
Wondering why prefer investing in outsourcing medical billing service over giving those duties to the in-house revenue cycle management team?
Because a minor mistake or missing out on a piece of information can have a considerable impact on your healthcare practice’s financial health, possibly leading to loss of patient and revenue.
Incompetent medical billing and coding practices can subject your healthcare to legal and ethical consequences. Improper documentation, piling up claim denials, non-cooperative front desk system, the patient no shows, poor account receivables management, medical transcription discrepancies if not managed by a trained and certified professional can cost your healthcare practice a fortune. Furthermore, aside from evolving with the CMS and HHS policies, practices have to make sure there operation and management is compliant to the HIPAA policies.
Why should the medical staff with the sole aim to treat and make people healthy be worried about all this when they should be focusing on delivering quality treatment?
Because even the noblest of the profession like saving lives needs money to continue doing so.
But as aforementioned while many healthcare practices are outsourcing the medical billing and coding, a large number of medical practices are apprehensive about it because of the prevailing misconceptions, which are stopping them from having a streamlined revenue cycle. If you are one of these practices, then you need to get a clearer picture by reading about them:
❏I WOULD BE VIOLATING HIPAA POLICIES BY OUTSOURCING:
No, you won't. By outsourcing, you will get a dedicated team of trained and certified billers and coders, who possess knowledge of HIPAA policies and would only proceed by adhering to it. If by violating HIPAA policies you are referring to the sharing of information, then you should know that it is done through a secure encrypted online system.
❏OUTSOURCING ENTIRE RCM IS THE DEAL:
A revenue cycle comprises of several different departments which are responsible for the smooth running of the practice, but this isn’t necessary that you will have to outsource the entire RCM. If you have a team of experienced and certified coders, you can outsource the billing aspects. Take, for instance; you have certified experts managing the claims, then you can then only outsource coders for charge posting.
❏I WILL LOSE CONTROL:
Fearing losing control at the hands of an outsourced agency? Well, you shouldn't. Because while they might be companies blindsiding the medical practice, leaving them out of all critical decision and strategies, you should be cautious to select the right one. A credible medical billing service will know the importance of involving hospital authority in its financial process, to make sure everyone is on the same page. Continuous and transparent communication is necessary between the healthcare practice and outsourced agency, but only a reputable RCM agency will ensure that.
❏SPECIALITY WON'T AFFECT MUCH:
There are more than hundreds of specialties in the medical field such as oncology, gastroenterology, behavioral health, etc.. Every specialty has a different diagnosis and procedure code. To think that specialty, when outsourcing medical billing service won't matter, would be committing a blunder. With different codes and standards laid down, it is crucial that you only outsource from a service provider with demonstrable experience in specialty-specific billing and coding.
❏OUTSOURCING IS TIME CONSUMING AND EXPENSIVE:
This is far from the truth. Let’s say, your in-house team did billing and coding for a specific patient, but a minor error in the coding led to claim denial. Now, what will happen? You will have to wait for the time window of re-filling the application to open, again file the claim with accurate details, wait for the approval and thus get your reimbursements days or months later than what you expected. Medical billing and coding service providers come with knowledge and experience of managing every minuscule aspect of RCM ensuring things are done correctly, freeing up time for practice to grow more. Outsourcing billing and coding will ensure minimum errors and maximum reimbursement
How is outsourcing medical billing and coding service helpful?
❏Outsourcing to a proficient medical billing service will help your practice stay aligned with the healthcare market that is evolving at a rapid rate.
❏Not only will your reimbursement spike up but you will have a better knowledge of your account receivable as you will get more insight into your patient, competitors data.
❏The reduction in billing errors and policy compliance will save your practice's significant time and accelerate the cash flow. This way you will be better able to invest time and other resources on patient care.
❏Outsourcing is also profitable from an analytical point of view as you will get more data regarding your practice’s financial health with defined metrics. The outsourcing agency will have information about the lagging areas, competitors, according to which they will keep back up plans to maximize reimbursements.
While it is understandable to go for a company claiming the shortest turnaround time and maximizing reimbursement, what needs to be kept in mind is; is their success rate demonstrable?
Look for medical billing and coding companies that offer risk-free 30 days trial period no long term contract obligation to put their services to test, so that you can decide whether or not your RCM will be proficiently managed.
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