These days, managing a medical practice is very complex. The medical billing process (also known as Revenue Cycle Management or RCM) is the most crucial part of running a successful practice, but also one of the most complicated.

Therefore, physicians are increasingly outsourcing this side of their business. The list of medical services provided by third-party companies, such as ACMBS, is extensive and include following:

• Accurate medical coding review and electronic medical claim filing

• Specialty billing

• Communication and follow-up with insurance carriers (and their ever-changing policies)

• Insurance appeal processing

• Handling of accounts receivables

• Patient billing

• Communication and follow-up with patients (including establishing payment plans, resolving balance disputes and responding to patients’ billing questions)

• Electronic payor processing and direct deposit

• Practice management

• Fee analysis

• Collection agency referral

• Credentialing

As if the list of services alone isn’t enough reason to outsource medical billing, here are four big reasons why using a medical billing service is better than keeping medical billing in-house.

Increased Revenue

The increased revenue associated with using a medical billing company as opposed to completing billing in-house is significant.

To illustrate, we’ve borrowed an example from Software Advice, who provides a hypothetical cost analysis for a medical practice they called General Physicians Practice with these characteristics:

• Four primary care physicians

• Two medical billing specialists

• $2,500,000 of billed claims per year

Here’s a breakdown of their annual costs and expenses for in-house vs outsourced medical billing:

For this example, using a medical billing company would result in a net gain of more than a quarter million dollars over keeping medical billing in-house.

That’s because medical billing companies know how to utilize the medical coding system in a way that maximizes revenue for the healthcare practice. Additionally, when a claim is denied or goes unpaid, the company puts in the sweat required to make sure physicians get paid properly for services rendered.

Cost Savings

Most physicians don’t have the time to hire, train, and manage an administrative staff. They’re busy enough taking care of their patients and handling other operational tasks. At the same time, patients expect undivided attention from their doctor.

Medical billing requires an immense amount of time and training to remain abreast of the coding requirements, changing standards and new legislations. As experts in their field, medical billing services handle coding and billing quickly and efficiently – and eliminate claim errors by billing and filing correctly the first time. Ultimately, this means providers will experience more prompt payment for claims when using a billing service.

Medical billing companies also have the ability to find new ways to code services in order to get providers the most money for a particular service. Many medical practices now consider these kinds of “work-arounds” necessary to take a more aggressive approach with insurance companies, as they deny more and more claims. Experts in their field, outsourced medical billing companies have the knowledge required to discover creative solutions that result in higher revenues for providers.

Medical billing companies like ACMBS get paid on a set percentage that the doctor gets paid for each service. The more money they help providers earn, the more money both parties will make. It’s a true partnership with both parties driven to maximize revenues. But beware… not all billing companies operate this way. Many third-party companies get paid per claim regardless of whether or not the claim gets paid. Be sure to outsource to a medical billing company like ACMBS that is fee-based and only gets paid when the provider receives payment. This motivates their team to work harder for their clients.

In contrast, an in-house biller is commonly paid hourly or by salary. Realistically, they’re less motivated to ensure physicians get the best rate because they are drawing their income regardless of whether the provider is getting paid for their claims or not.

Keeping medical billing in-house can also bring on challenges that can slow or halt cash flow. If an in-house medical biller gets sick, goes on vacation, takes leave, or quits, your operations and cash flow are stalled.

Another factor to consider when comparing the costs of in-house vs. using a medical billing company is that expenses incurred through in-house medical billing often exceed the cost of outsourcing. In-house expenses include the aforementioned administrative salaries as well as employee benefits, software, training, supplies and equipment.

Decreased Liability 

Medical billers hold the stress of handling tons of insurance and security protocols. Outsourced medical billing services truly understand the repercussions of HIPPA privacy and PHI security violations, which can be enormous liabilities for providers.

Keeping medical billing in-house requires oversight to ensure billers aren’t ignoring encounter forms, discarding superbills, or failing to appeal claim denials due to a lack of time or knowledge. Using an outsourced medical billing company eliminates these additional review tasks and concerns.

Outsourcing medical billing means passing off the complex responsibility to a trustworthy and knowledgeable source. Questions and concerns about insurance claims are eliminated as does the concern that a provider is getting paid the best rate for services rendered.

Accuracy & Compliance 

Medical billing providers are experts in the insurance field. When using medical billers in-house, physicians risk low claim success rates. This can be seriously threatening to your revenue and your business.

Reports show that medical billing claims are incorrect 10% of the time which can impact revenue by more than 11%. Outsourcing a medical billing service with experts who specialize in avoiding these issues means avoiding these risks and gaining peace of mind that finances are handled professionally.

It’s the full-time job of the medical billing service to ensure practices following legal insurance protocols. Plus, outsourced medical billing providers have the means to focus all their time on mending any rejected claims so that providers receive payments quickly. 

The trend to outsource medical billing is increasing ultimately because third-party medical billing companies exist to maximize revenue for your medical practice. Medical billing services increase revenues, decrease expenses all while providing peace of mind as they take on the responsibility of liability, accuracy and compliance.

Are you a provider seeking to increase your cash flow? Contact Ancient City Medical Billing Services to get started.