Medical billing is the payment practice in the United States health system for reimbursing medical expenses for procedures, treatments, and testing from health insurance companies. It can be availed either by the insurer or the patient. The medical billing process has now become complex due to massive mergers, partnerships, and acquisitions in the healthcare industry, which has created a lot of manual work for the health provider’s staff. However, with medical billing outsourcing services much of the spade work can be mitigated and at the same time complying with all HIPAA requirements.

Effective Medical Billing Services accelerate cash flow by taking care of a range of requirements. These includes managing patient’s demographics, patient enrolment, quality assurance, insurance verification, and pre-authorization.  They also check if there is a medical necessity and financial condition of the patient to estimate his liability.

Some Astounding Figures About Medical Billing

medical billing trends

In 2020, the U.S. healthcare outsourcing market was estimated at $52.9 billion, and by 2025 it is expected to reach $66.3 billion growing at a CAGR of 3.8% in the forecast period. The study is based on the analysis of the market shares of leading companies, market trends, demands, drivers, and challenges.  The sudden outbreak of the novel coronavirus disease (COVID-19) is assumed to further enhance the outsourcing market growth.

Medical Billing Outsourcing Will Become the Backbone of US Healthcare Industry by 2025

Certain parts of the US mainly North America have driven the demand for medical billing outsourcing market in 2018, owing to high awareness about healthcare IT outsourcing services, rising demand for specialized coders, quality healthcare services, and the initiatives taken by the government.

Some of the factors that have fostered the expansion of the Medical billing outsourcing market in the US:

  • Rising healthcare expenditure due to the need for efficient medical billing and increasing patient flow in hospitals.
  • Being a developed nation, the healthcare system of the United States is well established, and more companies are willing to go paperless.
  • Reducing the burden of huge patient flow management in hospitals.
  • The per capita income is high in the country; hence there is no cost barrier involved.
  • Availability of a large number of medical coders outside the US.
  • The adoption of advanced technologies by third party vendors to expedite the intricate processes.

Here are some of the latest Medical Billing and Coding Trends that are followed by the outsourcing companies:

  • EHR Implementation: Implementing electronic health record (EHR) for managing reports results in fewer coding errors. It fosters healthy doctor-patient relationship, reduces coding complexity, and processing claims faster.
  • Computer-Aided Coding System: With a CAC software, healthcare documents analysis and producing appropriate medical codes can be done easily. It recognizes ICD-10-PCS codes, ICD-10-CM diagnoses, and CPT processes. The computer-aided coding market globally was estimated at USD 2.76 Billion in 2017 and is expected to achieve a CAGR of 11.5% and reach USD 4.75 Billion by 2022. Hospitals, physicians, clinical laboratories, academic medical centres, and other healthcare institutions are using it on a massive scale.
  • Blockchain: With the advent of blockchain technology, experts are predicting blockchain’s potential in EHRs. Blockchain data storage assures privacy, security, and data exchange efficiency. It is also used to transform RCM and process claims faster.

The Benefits of Outsourcing Medical Billing Will Spur It Grow Be Leaps and Bounds in Years to Come

benefits of outsource medical billing services

Outsourcing medical billing is one of the best options that help in allocating financial and human resources efficiently. Professional HIPAA compliant healthcare medical billing outsourcing companies are the perfect choice for American physician firms, clinics, hospitals, and billing companies. Medical billing is driving the trend for clients and is a tool for bringing more business profits. Medical Billing Companies in the US are outsourcing a majority of their operations for a number of reasons. Following are some benefits that can be gained when opting for medical billing outsourcing:

  1. Boosts Cash Flow with Reduced Costs

Partnering with an outsourcing medical billing company is accelerates the revenue potential by 30%. Medical billing outsourcing services maintain consistent cash flow. Hospitals can achieve a greater economy with a specialized firm handling the billing work. Payments are made faster, and the investment in training the staff can also be avoided.

  1. Improves Patient Satisfaction

With outsourcing service providers handling the billing work and maximizing the revenue, healthcare providers can focus better on patient care. Outsourced medical billing services make sure that every code gets correct reimbursement, errors are reduced, and denials are managed.

  1. Automates Insurance Coverage Verification

A medical practitioner can hire part-time personnel to handle medical billing. Automating insurance verification will give you access to the patient’s immediate information, such as the maximum number of visits made for a particular illness or becoming ineligible due to some reasons. Automating ways to find solutions can reduce payroll costs significantly.

  1. Reduces Errors in Billing and Coding 

Outsourcing responsibilities can save a practice time and money. Third party vendors bank on advanced software. Medical billing software ensures no coding errors or incorrect information in the claims before submission resulting in fewer denials and fewer pending claims. With an efficient medical billing partner, you can look after the financial aspects of your organization better.

  1. Faster Claims Processing

Automating administrative tasks will result in more productivity and also empower a provider’s cash flow. A properly coded claim can be backed with EHR for maximum reimbursement and full payment in a pre-decided number of days.

  1. Data Security

A professional medical billing firm will strive to protect all the patients’ information, which is critical. They have all the advanced security measures in place to make sure there is no data breach.

  1. Billing Compliance

A HIPAA compliant healthcare and health plan process is critical to a billing service. Such a company will work hard to ensure that compliance is integrated into all operations.

What are the factors that invoke the need for Medical Billing Outsourcing? 

Outsourcing is nothing new to the world and has its own benefits in all industries. Following are the three topmost reasons why outsourcing is implied by healthcare industries for medical billing:

  1. Errors in Billing:

Insurance companies want correct medical billing and even the slightest mistake on the insured person’s part can lead to rejection of the claim. It has been found that 80% of bills have errors. This leads to a long and time-consuming process for the doctor to fix the error, resubmit the claim, and wait for the new claim to be accepted and processed.

  1. Denial of Claims

Insurance company rules are evolving because of which the medical practices are losing money due to ignored claims, denial of claims, and underpayment.

  1. Failure in Adhering to Updates

The constantly changing rules have a direct effect on cash flow and profits. Updates administered with the Health Care Reform have enhanced the number of insured Americans by more than 30 million. Hence, proper medical billing procedures are the need of the hour.

Reasons for Outsourcing Medical Billing

It is critical for a healthcare provider to outsource medical billing. As medical billing and coding are done simultaneously, chances of errors can be high when done in house. Outsourcing this task will let this be handled by expert hands and will give providers time to concentrate on their core business functions. Some of the key outcomes that can be obtained by outsourcing medical billing are as follows:

  1. Increased Revenues: Once assigned the medical billing task to an outsourcing company, organizations can save a lot in the salaries, infrastructure, purchase, upgrade, and maintenance of billing software. Timely submission of claims and reimbursements will result in increased revenues in turn.
  2. Increased Control: Firms can have better control over their medical billing processes and the money involved due to a well – trained and dedicated outsourced billing staff.
  3. Increased Safety:  Reputed outsourcing companies provide a transparent billing process. They adhere to the HIPAA compliance and 100% secure medical billing processes for protection against hacking and phishing attacks, leaving the data vulnerable. Outsourcing providers have the security to keep the information confidential and necessary infrastructure for safe medical billing outsourcing.
  4. Reduced Extra Costs:
    With outsourcing, the need to hire a team for medical billing does not arise. Hence, the money spent on training them will also be saved. Moreover, the company also doesn’t require investing in the billing software too.
  5. Patient’s Well-Being: With the medical billing processes outsourced, health practitioners will have more time to concentrate on patients care. The staff can ensure that the patient’s financial matters are handled by an expert service provider.
  6. Adherence to ICD-10 and ICD-11: Outsourcing medical billing ensures that the ICI-10 and ICD-11 coding systems are followed. The outsourcing staff will be well-aware of the sweeping regulations and will leave no stone unturned to fulfil it to provide a hassle-free claim on time.
  7. Expansion Possibilities: The expansion of a medical company can increase the expenses on real estate, infrastructure, recruitment, etc. Thus, if they choose to expand through outsourcing, it can be done immediately. The outsourced company will also motivate them to make a faster expansion as they also get the opportunity to grow.
  8. Government Stability: Companies outsourcing their work to other countries with a stable government such as that of the US, encourages them to get international projects and increase the rate of employment. The government also provides subsidies to the IT companies, helping outsourced companies to keep their costs to the minimum.
  9. Language Benefits: Another worth mentioning reason to outsource is taking advantage of reducing the communication barriers with the clients because of their English-speaking skills which is a primary requirement of US-based healthcare providers.

Offshore service providers have trained employees who know the business requirements of outsourced medical billing and coding. They keep track of every outsourced claim and make sure that the amount is processed fully, and the overheads are reduced.

Medical Billing and Coding During Covid-19

With the advent of Covid-19 pandemic third party vendors are working round the clock to bail out overworked healthcare providers. Outsourcing the core functions to the external companies has proved out to be a boon to the healthcare companies. By outsourcing they have gained in the following ways:

  • Generate specific medical codes against different services, to avoid any confusion in the treatment plans and billing process.
  • Manage the patient’s record by transcribing the details onto online systems. This includes the patient’s history, insurance policy details, and the mode of payment.
  • File insurance claims and follow up with the insurance companies.

Due to the prevailing conditions, majority of the healthcare workers are staying at home thereby causing a severe shortfall in resources. This has made the going tough for all healthcare providers. However, by outsourcing medical billing services can be advantageous as they can execute the assigned tasks with their trained staff and help healthcare providers wade through the crisis.

The medical billing outsourcing companies manage insurance verification efficiently. Most importantly it assists healthcare providers to manage the billing processes across the hospitals. All these factors are expected to contribute to the US medical billing outsourcing market to expand rapidly over the forecast period and observe steady growth by 2025.

Who we are and what Makes us the Authority of Medical Billing Outsourcing?

At Medbillingexperts, we promise to make the billing practices more accurate, consistent, and reliable with our extensive experience in assisting healthcare providers. We aim to reduce the billing mistakes by verifying and re-verifying critical eligibility information from the insurance provider. We review the claim information in a multi-tier process to ensure all the fields are completed as required. We also ensure up-to-date awareness, asked by third-party payers filing insurance claims. We follow an authentic step by step process such as checking for insurance eligibility, appropriate medical coding, quality check for filing, and claiming bills in order to avoid denials later.



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