Should You Consider Outsourcing Your Medical Billing?

by  Find-A-Code™
Jun 16th, 2023

Every healthcare provider that accepts payments from insurance plans or Medicare/Medicaid needs to engage with the modern medical billing system. It is unavoidable. Sometimes, keeping up can seem like more trouble than it's worth. But since it is the only way to get paid, clinicians and billing departments have no other choice. Yet there is one thing that could make billing easier: outsourcing.

Outsourced medical billing is no different from any other outsourced service. Outsourcing sends tasks your organization isn't properly equipped to handle to a third-party partner who specializes in those tasks. When you outsource medical billing, you are turning the entire billing process over to a company whose expertise is medical coding and billing.

Why Organizations Do It

Professional medical billing services can be found across the country. Medical billing is a robust industry supported by small and large providers alike. Those providers hire expert medical billing staff who know their stuff. But of course, organizations need to pay for services. So why do they do it?

Some organizations outsource medical billing because they actually save money. Not having to hire and maintain their own billing staff also means not having to pay additional salaries and benefits. It can mean a lower office footprint too as extra space to accommodate the billing department isn't necessary.

There are other reasons organizations outsource medical billing:

• Streamlined Administration – Outsourcing takes the burden of medical billing off administrative staff. Without that work, staff can concentrate on other administrative tasks.
• Industry Expertise – Because outsourcing partners specialize in medical billing, they also bring a level of expertise to the table that in-house staff do not necessarily possess. That expertise often translates into fewer errors and a more streamlined billing process.
• Improved Cash Flow – When billing errors are reduced, cash flow improves. A more accurate and streamlined billing department improves cash flow by ensuring bills are submitted and paid on schedule.
• Billing Accountability – Though there are exceptions to the rule, a typical medical billing service has procedures in place to track and follow-up on all claims. This adds a level of accountability in that there is now a second stakeholder staying on top of payers.

Professional medical billing services are well worth the investment in many cases. Outsourcing may not be the right choice for every healthcare facility, but when it is the right choice, it tends to reap significant dividends.

Pay Attention to Pricing Models

Investing in professional medical billing services obviously adds an expense to the monthly budget. So the one thing to be careful about here is pricing models. For all intents and purposes, there are three ways billing providers charge for their services:

• Volume Percentage – Some medical billing services charge based on volume. Their pricing is set at a certain percentage of the total amount collected. By tying payment to collections, services are motivated to be more accurate and timely.
• Flat Fee – Other medical billing services charge a flat fee on a per claim basis. Fees can be influenced by volume, in the sense that a higher volume of claims are billed at a lower fee. Lower volumes are subject to a higher fee.
• Hybrid Pricing – A smaller number of medical billing services utilize a hybrid pricing model. Typically, this sort of model starts with a fairly low flat fee to which a percentage of the collection amount is added.

Pricing models aside, there are valid reasons for outsourcing medical billing. Healthcare providers do it to save money, reduce errors, hold payers more accountable, and get access to a level of expertise they are otherwise missing out on.