One of the most complex, complicated, and challenging aspects of running a medical practice is medical billing. With thousands of possible medical billing codes for diagnostics and procedures and multiple payers, the possibility of executing efficient medical billing is a real challenge. There is no one-stop solution for all aspects of medical billing. Still, there is one immediate solution: to outsource your medical billing with an efficient medical billing firm, which has the expertise and experience of conducting different aspects of medical billing proficiently. However, a medical practice may also have the option to conduct internal billing through a practice management system (PMS) with or without an EHR (electronic health record) system. Medical records (EMR) can also be outsourced to a medical billing company.
Conducting In-house Medical Billing Services
The front office staff is responsible for all aspects of the revenue cycle management. They submit their claims to a clearinghouse or directly to Medicaid or an insurance company for reimbursements, setting charges, collecting patient fee registration, and account receivables.
Conducting Outsourced Medical Billing Services
Providers can outsource their medical billing to a third party called a medical billing service firm. These medical billing services typically accept a percentage of a practice’s total collections as payment for
managing many aspects of the revenue cycle. There may also be recurring medical billing events for a monthly fee.
It is essential to determine whether to keep billing services in-house or outsource them. Cost-benefit ratio analysis is required to determine whether the practice’s billing costs in terms of staff, training, technology, and other resources are justified with the cost of contracting an external medical billing organization.
A clearinghouse accepts electronic claims from medical practice management software (PMS). They scrub off the claims for obvious reasons for claim rejections if, for example, the date of birth is not included in the application. Then they put the claims in a universal format and electronically submits them to insurance companies for processing. Some clearinghouses offer more services than others. Clearinghouses often partner up with individual practice management systems. PMS recommends or concludes a contract with the clearinghouse. Sometimes the medical team pays the clearinghouse directly, or it is included in the services. These costs are generally billed per claim with a minimal charging fee.
Outsourced Medical Billing
On the other hand, outsourced medical billing services provide complete and comprehensive revenue cycle management services. An outsourced billing service company such as GreenSense Billing has its own PMS (Practice Management Software), and they can also outsource to the clearinghouse for claim submissions, scrubbing, and submissions. Generally, outsourced billing service providers charge a minimum percentage of the revenue generated.
Here are some pros, cons, and considerations that you may want to explore before deciding to either conduct your medical billing in-house or use outsourced medical billing services.
In-house Medical Billing Considerations
- Whether existing employees can do medical coding and billing all by themselves and conduct front office tasks. Medical providers and managers appreciate having hands-on control of all the financial transactions through in-house medical billing.
- Once a practice has invested in training or hiring medical billers and purchasing medical billing software, then moving towards an outsourced medical billing solution would mean losing a lot of time and money spent
- When there is an established system, then it is worthwhile to simply refine or manage existing medical billing tasks and processes to generate the best return on investment
- If there is an issue, then accessibility of your in-house medical billing department proves to be a significant advantage. They can observe and address any problems promptly
- In-house medical billing maintains patient confidentiality with strict control over their medical history and data
- There can be additional costs for labor, software implementation, expert staff, technological hardware, medical billing software purchase, and subscription fees and maintaining the medical billing function of the practice
- If all the medical billing and coding staff is not up-to-date with the latest regulations or information, then there can be higher rates of claim denials, un-appealed claims, and lower reimbursement rates
- Suppose the medical billing department consists of a few staff members. In that case, the billing operations and cash flow may suffer and can be disrupted if an employee gets sick, goes on vacation, takes a leave of absence, or even quits the job.
Outsourcing Medical Billing Considerations
- When a clinic or a medical hospital starts to outsource its medical billing, it is usually considered as less expensive, as they would only have to spend a small or a minimum percentage of all generated revenue, which still depends on the revenue being generated from the clinic or the medical hospital. Outsourcing medical billing services then does seem to be a more economical option.
- An outsourced medical billing company must provide the latest and most sophisticated medical billing software, with the latest medical billing tools
- Having access to people with hands-on experience in medical billing and coding
- Having competent staff who are up-to-date with all the recent and latest changes with all medical billing regulations and policies and is HIPAA compliant.
- Provide all the necessary medical billing and coding rules, policies, and regulations training for the clinic staff
- Timely, proficient, and effective account receivables management for the medical practice
- Ability to identify medical coding or patient registration errors and can communicate those to the appropriate, relevant staff before submissions
- Help and supply the clinic with comprehensive financial and performance reports in customizable templates which are easier to understand upon request
- Provide success rate for all claim submissions and resolutions
- Having and maintaining control over claim submissions, denials, and resolutions
- There can be possible misunderstandings over contractual agreements between the medical billing firm and the practice owner
- HIPAA privacy, compliance, and patient medical data security can always be a concern when outsourcing medical billing
There can be other important questions to consider, such as if a medical billing firm offers long-term contract obligations or not, or considering the size of the medical practice or patient visits. All such types of questions can also play an essential and vital role in considering in-house or outsourced medical billing services for a medical practice.