Whether you have a small or big practice billing is a crucial part of your practice. The health of your practice depends wholly on how efficient your billing process is. The best way to have an efficient process in place is having the right tools and dedicated billers and coders with great exposure to claims and reimbursements. While this may be easy for a large practice, it isn’t so easy for a small practice. So, where do they go? They outsource their medical billing requirements to a third-party partner. And given the benefits of outsourcing, large practices prefer to follow their junior counterparts. The more important question however is when to outsource billing to a third-party company? And the most important question is how to choose the right partner for your service.
Know When to Outsource Your Medical Billing Process
If you are not sure about outsourcing you can use the following circumstances as guidelines
- Your patient accounting system is backdated and is giving up.
- You are facing problems everyday with credentialing issues.
- You’re finding it challenging to cope with a constantly changing reimbursement models.
- Your net revenues is weak and have to put up with poor cash recoveries
If any or all of the above trigger apply to your practice, it’s time to give outsourcing a serious thought. Outsourcing not just helps you get the better of the particular trigger slowing your recovery down, it also stops the rot from stemming in. In other words, they help you avert causes that can lead to slowdowns.
Here’s 4 common ways in which BPOs have been helping practices overcome:
Obsolete Patient Accounting System
A patient accounting system is the most critical part of a hospital information system, It helps practices calculate healthcare costs, store financial data, and provide patient billing information. Every practice must have an information systems designed to meet its particular requirements. Sometimes practices have to depend on obsolete accounting systems that lead to several bottlenecks.
Read Also Benefits of Outsourcing Medical Billing and Coding during COVID-19
In today’s data driven age, it’s imperative to have an information system that helps files to be changeable, and readily available for analysis. This is where the experience and expertise of a solution provider can make a big difference. A third-party vendor will provide you with the best patient accounting tools to manage your requirements end-to-end. For small practices this can come as a boon. Further, they will help you streamline your billing process by designing operational goals and defining metrics along with efficiency reviews for procedures and policies.
Delay in Payments Due to Credentialing Issues
Small and large practices have to put up with several credentialing issues because of lack of staff or regular attrition. As a result, verifying credentials, completing enrolment applications accurately and maintaining up to date information becomes a never-ending challenge for them. Most practices compromise their medical credentialing process by not allocating enough staff to handle the process efficiently. This leads to an overworked staff, errors in enrolment applications and delays in reimbursement. In half of the cases it leads to denials.
Assigning this task to a healthcare BPO company can ease things out in many ways. They will help you collect and review all the documents and make it accurate and complete before submitting it to the payer. As a result, you can do away with less staff or even avoid making your staff overwork. They bank on a well-driven process to make credentialing a less time-consuming task and ensure all providers are credentialed on time. This translates into least delays in payment or denials of claims. Yet another advantage is that they help you maintain a healthy working relationships with all the payers and advance your interests without any hassles.
Changing Reimbursement Models
Adapting to changing reimbursement models is a challenge for all in general and for small practices in particular. Pulling themselves out of the comfort zone of a proven method of getting paid slows things down and leads to unanticipated errors. No matter how much practices dislike, they need to adapt themselves to the changing models with lightning speed.
Today, reimbursement models are undergoing a constant change. As of the today, a patient has become a more integral part of the payment structure. Reason being high-deductible health plans (HDHPs), rising copays, and a move to greater patient responsibility. Health insurance providers are no longer required to cover the bulk of the patient’s bill. Instead what has come in place is a blended reimbursement model which makes the patient responsible for bulk of the treatment charges.
Read Also Why Medical Billing Outsourcing Will Become the Cornerstone of US Healthcare Industry by 2025
It is against this backdrop that BPO services can be very handy. They can ably assist you in adapting seamlessly to a new third model without you losing your footing in managing a blended payment model. The need to manage billing and payment collection from both payers and patient can be a very delicate task and calls for a calibrated approach. BPOs can help you strike the balance needed to collect all outstanding from payers and patients alike. Their comprehensive solution which covers verifying eligibility, estimating patient responsibility, communicating with stakeholders, collecting payments at point of service, and following up with delinquent services will ensure you leave no money on the table.
Revenue Leakage Due to Denied Claims
Medical revenue cycle is a complex network of inter-connected processes. It’s because of this complexity that the process is more often than not rendered inefficient and results in constant revenue leakage. What’s worse, the leakages go undetected many a times and lead to losses that add up to thousands of dollars. Some common issues faced by practices include un-billed or incomplete procedures, inaccurate claims; enrolment issues leading to denials related, incorrect patient balances, inefficient denial management process, underpayments and fee-schedule problems, front desk related Issues etc.
When you entrust this task to a healthcare bpos, all such loopholes get plugged. For instance. they have expert medical coders to identify leakage points. The coders compare reports of patient appointments, go through the procedures performed & scan the claims submitted to spot the issue. Likewise, their credentialing process is driven by an experienced team that knows the ins and outs of payer-specific credentialing and re-credentialing so that you get complete control over denials.
What’s most important is that BPOs help you create a smooth patient balance management process. They have a well-defined process that helps in sending timely reminder through calls and texts, and developing a easy payment plans to ensure collection. They help you avoid underpayments by planning, revising, and updating your fee-schedule in keeping with the changing guidelines of payers.
With these meticulous services your practice can accurately spot the weak link in your collection process. Their end-to-end services help you create clarity about patient responsibility, get fully reimbursed with flexible payment methods, and build relationships with patients by maintaining regular communication.
Who We are and What Makes Us an Industry Authority?
OutsourceRCM is a specialized healthcare BPO company specializing in providing medical billing and coding services to small and big practices in the US. We have a proven track record of maximizing our client’s process efficiency and cutting operational costs. We blend our experience with our end-to-end coding knowledge to assist our clients negotiate all bottlenecks to complete reimbursements. We eliminate additional resource expenses by working as an extension of your team. We have served a large number of clients; from single to group practices and from large hospitals to medical centers, radiology groups, etc.
