Medical Billing Outsourcing or In-House Medical Billing – What to Choose?

by | August 28, 2019 | 9:29 am

In the past, most DMEs, HMEs, and practitioners were doing their medical billing in-house. However, more recently, with ever-changing regulations in the medical business, implementation of the complex ICD-10/ ICD -11 coding system, and a federal mandate to implement EHR (Electronic Health Records), various companies are now outsourcing their medical billing requirements.

In fact, the global medical billing outsourcing market is expected to reach $19.7billion globally by 2026.

Technology is the key for DMEs and HMEs to automate the back-end revenue cycle process, either in-house or through outsourcing. What matters most is what’s right for your practice. We’ve outlined a few points for healthcare providers to help evaluate and make the right choice.

  • Claim Success Rate

An accurate insurance verification process – the first and most important step in the medical billing process –  helps your billing staff send correct claims the first time for faster reimbursements. It helps reduce the number of rejected or denied claims and improves cash flow. On the contrary, an inefficient insurance verification process may result in denied claims, missed opportunities, or completely uncollectible claims. Moreover, since insurance companies regularly make policy changes, staying updated can be a huge challenge. Thus, relying on a well-trained team of medical coders who follow a streamlined medical insurance verification process will help increase clean claims and enhance patient satisfaction.

If you opt for in-house billing, you will be responsible for coding, submitting, follow-up, and presenting rejected claims. You will need to employ certified billers and coders, establish an IT infrastructure, and streamline the billing process to ensure that claims are submitted on time, accurately. However, your billing team may take a lot of time to learn correct procedures and codes and the right way to submit insurance claims.

Whereas medical billing service providers bring a skilled workforce with extensive experience in the field of medical billing and coding. They can perform these complicated tasks faster, error-free, and more efficiently. This not only results in a better claim success ratio but also ensures that you no longer have to micro-manage employees or deal with billing issues.

  • Cash Flow

What if your medical billing staff quits suddenly or goes on a vacation? Billing interruptions can seriously affect your collections and ultimately your cash flow. The administrative responsibilities and diverted attention due to insufficient medical billing staff can affect the quality of work. This may result in claim denials and poor patient satisfaction, which may affect your cash flow.

Outsourcing is more cost effective than training and maintaining staff in-house. By ensuring timely and accurate submissions with minimal denials, medical billing specialists improve collections and contribute to an increase in cash flow. Outsourcing medical billing partners offer quick, accurate, and efficient billing with fewer errors, increasing the collection rate, shortening turnaround cycle and reducing rejections and denials. Moreover, since medical billing providers take care of staffing, training, IT infrastructure, and other maintenance costs, they allows you to save critical revenue.

  • Billing Staff and Infrastructure Cost

Employing certified billers and coders in your in-house medical billing team can be expensive. Common staffing issues like recruiting, retaining, attrition, and training can be costly. In addition, meeting overhead costs like salaries, employee benefits, 401(k), and payroll software can be a challenge. Additionally, the cost of scaling up your in-house medical billing team can be huge, increasing overhead costs and capital investments in billing software and IT infrastructure.

By outsourcing medical billing, you get instant access to highly skilled specialists and a world-class IT infrastructure on an as-need basis. Further, outsourcing the medical billing process allows you to transfer day-to-day administration of critical functions to specialists and scale workforce without a loss of efficiency. This eliminates the need to invest time and money in staffing and infrastructure.

  • Security Breaches

According to Identity Theft Resource Center (ITRC), internal errors are responsible for more than 90% of data breaches, which primarily includes employee errors, unauthorized access, and accidental web exposure. As the rapidly changing healthcare regulations and compliances grow more complex, it can become tedious for your in-house medical billing team to stay on top of the ever-changing regulatory framework and new policies. Especially now that HIPAA violations and data breaches attract heavy penalties, juggling to stay updated with rapidly changing protocols and regulations, while also maintaining routine billing compliance and tending to daily patient needs can take a toll on health practitioners.

On the other hand, medical billing providers stay up-to-date on the latest compliance requirements, giving you the confidence to meet HIPAA compliant medical billing, safeguard against any security breaches, and ensure the privacy of patient data and billing accuracy.  

  • Transparency and Accountability

In-house billing helps you retain hands-on control over billing operations and patient data. However, it can also be a hotbed for largely unnoticed internal errors,  adding up to high costs, more than what you would pay to a third party billing partner.

A skilled outsourcing medical billing partner can help make the billing operations more efficient and transparent by tackling the root cause of rejections or written-off claims. Moreover, you get enhanced transparency with a dedicated dashboard, real-time reporting, and comprehensive daily, weekly, and monthly performance reports that allow you to analyze and continue to grow your medical practice.

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