Outsourcing medical billing and coding has long been on the rise for many reasons. However, in the face of the COVID-19 epidemic, outsourcing these services has never been more critical. This is because of the staff shortages involved and the rate at which regulatory bodies have been implementing changes to coding requirements and other regulations.
If managing claims before was a nightmare, there are no words to describe how daunting a task it is when faced with COVID-19 complications. Not only have costs risen in hiring more staff to handle back-office functions, operations have also become that much more complex. To understand just why outsourcing medical billing is needed at this time, more than even before, let’s go over the challenges first.
Increase in Costs
The COVID-19 epidemic has taken over the healthcare industry in ways that could not have been foreseen. Not only have costs been rising with last-minute investments in hygiene training, sanitation, and infrastructure, but spending on IT resources has also increased. Without the right sanitation and infrastructure in place, healthcare facilities would not be able to provide medical attention to those in need and prevent the illness from spreading.
From medical gloves and masks to hand sanitizer and disinfectants, hospitals and other healthcare providers have had to invest in the right supplies to keep the disease at bay. They have also needed to incur additional expenses in procuring expensive medical equipment like ventilators to better treat COVID-10 patients.
This epidemic has also resulted in a greater need for medical coders and billers to handle the onslaught of claims. However, medical billers and coders are hard to come by as they are limited by their geography. They are also difficult to onboard at such a critical time because of social distancing requirements that have been put in place.
Because offices and other such establishments have been shut down to keep employees safe, it is almost impossible for healthcare providers to get a hold of more medical coding professionals immediately. This means that claims will keep piling up and healthcare providers will face massive backlogs due to the lack of personnel available to process them and follow up with insurance carriers.
Because talented medical coders and billers are hard to come by, the cost of hiring more personnel has increased as well. Healthcare providers have been facing large increases in labor costs because they have to pay staff for overtime as well. In acute care settings, they also have to pay specialists for the care they deliver along with the training fees associated with COVID-19 treatment.
Because COVID-19 treatment involves specialist knowledge, all personnel on staff have to be trained accordingly. This only increases the costs that healthcare providers have to face on top of large investments in IT infrastructure, sanitation, and hygiene training.
Increase in Complexity of Operations
With the COVID-19 epidemic comes an increase in operational complexities. This is because not only do personnel have to document a disease that has never been documented before, they have to do so at an alarming rate. The resulting confusion and chaos that arises from healthcare workers not knowing how to code certain conditions can be detrimental to a practice’s ability to function.
In fact, keeping the billing office open and running during an outbreak is critical to keeping practices and hospitals open for infected individuals that require medical care. But this can be a massive challenge, especially for smaller healthcare providers and practices with limited cash on hand to respond effectively to COVID-19 demands.
Beyond simple coding complications, medical coders and billers need to stay abreast of changing payer conditions and coding requirements at a speed that is much faster than the regular learning curve. CMS has already released 2 Healthcare Common Procedure Coding System (HCPCS) codes that laboratories can use to generate medical bills for certain COVID-19 diagnostic tests.
On top of that, the American Medical Association (AMA) has also announced that it is working on the development of a new unique CPT code for reporting any novel coronavirus testing. What this means is that the staff working at different healthcare providers around the nation need to get familiar with changing requirements in no time at all.
The CMS has already released guidance on reimbursement and billing for treating COVID-19 as well. The agency has confirmed that Medicare will pay for all evaluation and management (E/M) and related services furnished in a beneficiary’s home by a non-physician or physician practitioner. Medicare will also be responsible for reimbursing healthcare providers for a host of non-face-to-face services used to evaluate and manage a beneficiary’s COVID-19 condition.
This will require medical billing that is different from normal billing because of the special conditions imposed by regulatory bodies for pandemics. If medical coders and billers are not adequately trained in the new codes, there will be huge losses waiting for healthcare providers across the nation.
The COVID-19 pandemic was not anticipated, which has resulted in a shortage of specialized professionals in critical fields like insurance verification and medical coding. As community spread is becoming more rampant, healthcare practices around the country are finding themselves short staffed.
Even if the practice is in a central location like in a large city, it is finding it difficult to onboard back-office assistance in insurance verification and collections because there simply are not that many skilled professionals around in those fields of expertise. A severe shortage of skilled resources has made it impossible to handle a pandemic of this size with the efficiency that it demands.
Cost Savings Could Not Be More Critical
In the face of higher expenditures, investments, and costs, it could not be more critical to find ways to save money for healthcare providers. One way to realize cost savings would be to outsource medical billing to third-party service providers. Outsourcing would help healthcare providers not only reduce costs when it comes to hiring more personnel, but also cut IT infrastructure expenses.
This is because outsourcing partners have a massive workforce from which to draw experts out of to tend to your needs. Because most healthcare outsourcing firms are located out of third-world nations, not only do you have to pay considerably less to hire each resource, you also get to benefit from their sophisticated IT infrastructure instead.
Third-Party Medical Billers and Coders Have Years of Industry Experience and Accrued Expertise
Outsourcing medical billing to third-party service providers means that you get access to the most talented workforce at a fraction of the cost. This is because the best outsourcing partners are large organizations that have hundreds of employees from which you can choose to handle your project requirements.
These highly qualified agents would already be well-versed in newly developed CPT codes and HCPCS codes for diagnostic tests as it is their job to stay up to date with the latest developments in the healthcare industry. They would know which modifiers to use and what descriptions qualify for certain procedures so that you can maximize your reimbursements during this crisis.
They would also know how to process collections so that you have more money flowing in from patients that refused to pay off their debt previously. Outsourced medical coders and billers would also know how to handle denial management so that even your rejected claims are resubmitted and followed up with. The expertise they have in this field would bring greater streams of revenue flowing into your practice as more claims are properly reimbursed for the full amount.
Third-Party Partners Have a Great Track Record of Successfully Managing Remote Work
When you choose to outsource medical billing and coding services to third-party service providers in India and the Philippines, you are asking for great expertise in remote working. India, in particular, has successfully managed work from home type situations with the right IT infrastructure in place to support operations with zero downtimes involved.
Not only have these Indian service providers invested in providing laptops to employees take on these new remote working conditions, they have also put the right network infrastructure in place to ease remote workflows. This means that they have the right processes and systems in place to carry out back-office tasks from insurance verification and claims scrubbing to denial management and collections.
Third-Party Partners Have Access to the Most Cutting-Edge Technologies
Indian healthcare outsourcing companies also have access to some of the best software and technologies in the world. This is because they stay on the frontlines of technological breakthroughs by having so much of their workforce invested in the IT domain. Because of the expertise of developers and IT professionals in the region, most outsourced medical billers and coders have in-depth knowledge of software and technologies that can help make their job easier.
These include great proficiency in EHR systems and hospital management software. Other outsourced healthcare service providers have online portals that their clients can use to get their patients to pay for the medical treatment they received. Having the right infrastructure to support your operations is key and India is no stranger to that domain.
Medical billing and coding is tough enough as it is, forget about how complicated it can get by adding COVID-19 to the mix. Because most healthcare providers are not fully equipped to handle the COVID-19 crisis on their own, the need to outsource medical coding and billing has never been more critical. Not only does outsourcing provide greater control over costs, it also helps reduce the need to invest in IT infrastructure out of pocket as well.
Additionally, outsourcing these services means that healthcare providers can get access to the most cutting-edge technologies. Outsourcing medical billing support to locations like India also ensures that you have great expertise when it comes to remote work. If accrued expertise and cost savings are important to a healthcare provider, outsourcing medical billing could not be more critical at this point in time.
This is because outsourcing your requirements will help increase your collection rate, obtain an in-depth analysis of your AR, and help you reduce rejections and denials. Not only will it free your staff to work on providing medical care when it is needed, it will also help you reallocate resources and make better business decisions.
Who We Are and Why We are an Industry Authority?
This article is brought to you by MedBillingExperts, an enterprise-grade healthcare solutions provider for all your revenue cycle management requirements. We have witnessed many transformational changes in the healthcare industry over the 10 years we have been in business devising unique medical billing solutions for our clients. Our proactive response to the COVID-19 epidemic has helped us move our entire workforce, comprising of 3,000 employees, to remote locations.
We have equipped them with the necessary data collaboration tools and technical infrastructure required to facilitate seamless collaboration to handle their medical billing requirements. We have also developed a business continuity strategy around using a hybrid delivery model from multiple centers in India and the Philippines to extend our support to our clients at this time. We continue to work at full capacity with sustained commitment and zero downtime to alleviate our clients of their medical billing burdens.