According to MarketWatch, the global medical billing outsourcing market size is expected to reach $23.7 billion by 2027.
As businesses grow, the volume of clients and customers grows, and so does the need for reliable and comprehensive record-keeping. The need for outsourced medical billing assistance can prove useful at a time when more resources are needed to manage the influx of orders, without affecting the existing customer orders and requirements.
Given the DME/HME payment cycle, revenue cycle management begins at order submission. When new orders are accepted by the DME/HME, the staff needs to ensure:
- Patient details are captured accurately
- Insurance details are recorded
- Medical authorizations for the equipment being ordered are in place
Why outsource? The details that go into medical billing
Medical billing can be complex and time-consuming. Revenue Cycle Management (RCM) is a critical component of medical billing, factoring in patient information, equipment details, and authorizations and medical prescriptions. For DME/HME businesses to manage efficiently, they must have the time and resources to consistently ensure efficient RCM.
However, given the complexities involved in the RCM process, any error can also cost the business its revenue. Claim applications and payments depend heavily on the data and information recorded during the initial order-taking process.
#1 Need for trained staff
The DME/HME staff should be trainedto ensure they understand the order-taking process. For a busy DME/HME, ensuring this can be counterproductive. Outsourced medical bill processes can help relieve the administrative and back-end load off the staff, allowing them to focus on other critical aspects, including communication and due diligence on submitted documents.
#2 Technicalities of the billing process
Due diligence and an in-depth understanding of processes such as pre-authorization and even insurance verification is important for successful billing. Often, patients may not be aware of the documentation needed to confirm DME orders. Their caretakers may not be updated either. This can also be the case with insurance documents. Details such as exact amount of premium to be paid, or changes to premium payable, may be unclear to patients. Within insurance, there are several elements such as copayments and dependents. These details can influence the payment to the DME/HME.
The insurance company can choose to delay or deny payment if any of the required information is incomplete or inaccurate. Outsourced RCM services can help businesses streamline information management and processing to ensure more accurate and complete claim applications.
#3 Expertise and insightful experience
Given the layoffs and furloughs experienced by companies during COVID-19, outsourced medical billing assistance can help businesses tap into insightful expertise without scrambling to arrange it in-house. In the current unpredictable landscape, making capital investment in staff training may not yield expected returns if the individuals hired are unable to continue working as assigned.
Outsourced assistance enables businesses to hit the ground running, whether with trained staff or current infrastructure on which to carry out critical documentation, storage, and back-up. Outsourced medical billing assistance brings three important benefits to the DME/HME:
- Access to current and future infrastructure without the need to make capital investments.
- Freedom from the hassles of system maintenance, upgrading, and security updates.
- Ability to leverage expertise as well as infrastructure resources of outsourcing partner to offer service extensions to clients.
#5 Business growth
To ensure growth and long-term sustainability, a DME/HME business needs to pursue more efficient medical billing processes, insistence on compliance and management of vulnerabilities, as well as a measurable decrease in the in-house costs, especially hiring and training. All of these can be difficult to implement without the help of an experienced provider of medical billing services.
Efficient medical billing processes can further reduce financial expenses by streamlining RCM operations and increasing efficiency and reliability of the data obtained. Outsourced DME billing can help prevent data gaps and reduce revenue losses.
- A DME partnership can provide the right assistance and expertise to reliably manage DME/HME billing requirements, such that the business can continue to focus on providing quality healthcare.
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