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You have probably heard the saying “do what you do best and outsource the rest.” This saying can easily apply to medical billing and your front office operations. Some of the reasons to do so may be obvious, while other reasons you may not have considered. And there is even one reason why you may not want to. So for your consideration, here are the top 8 reasons to consider outsourced medical billing, and one reason why not to.

1. Be a doctor again
Remember, do what you do best and outsource the rest? You are a doctor, that is what you do best. All of the other functions of your practice are administration, which take time away from seeing patients when you are wrapped up in the day-to-day operations. Insurance carriers are paying less, your costs are rising, and you have to see more patients than before to make the same amount of money. Handing these functions over to an outside medical billing service can free up staff to perform other essential operations that sometimes get pushed aside. Likewise, outsourcing can also prevent your billing, collections, and follow up from being pushed aside as so often happens when the office gets busy.

2. Keep up to date
Insurance billing is more complex now than even just 5 years ago. Insurance carriers are constantly changing their rules, making updates, compliance and regulatory agencies do as well. And when the mandated switch to ICD-10 diagnosis coding occurs, there will be more than ever before to keep current with. The focus of a medical billing service is on the pulse of healthcare billing. A good medical billing company can be a partner to your success.

3. Reduce denials and collections
Denials can run up to 30% or more of a practice’s billing. Collections can be put off until the debt is so old it is uncollectable. Even having an in-house billing person dedicated to nothing else does not always resolve this. It is inevitable that other tasks will draw the attention of staff throughout the day. A medical billing specialist is dedicated to getting as much of your money for you as possible. After all, they do not get paid if you do not get paid.

4. Reduce expenses
This is a result of the last reason, as well as overall it is much more cost effective to outsource your medical billing. The cost to hire, train, and employ an in-house biller can far exceed that of sending your claims filing to an outside source. Plus, the motivation to collect your money for you is often times greater. In-house staff gets paid whether your denials and unpaid claims are 30% or 5% For an outside biller, their pay is tied to your pay. Who do you think is going to be more motivated?

5. Keep compliant without the cost
Think about what it costs you to stay compliant with your billing function. Keeping a compliance plan in place, training, education for staff. When you outsource, the cost of compliance and a compliance officer is taken on by the billing company who in turn is able to spread their cost out over several clients.

6. Technology is expensive - and requires constant updates
In-house billing software is expensive. And it requires constant updates which are expensive. Even if you use web-based applications, there are monthly costs associated with those as well. Pass these costs off to a billing company.

7. Payroll is one of your biggest expenses
The Society of Human Resources Management estimates that the cost of recruiting, hiring, and training a new employee is $3500. Finding qualified billers can be difficult as well. Factor in sick time, vacation time, employee turnover, benefits, taxes on employees and the cost of keeping billing in-house can add up.

8. Reduce employee theft
I wish I did not have to put this reason here, but you would be surprised at some of the stories I have come across. Unfortunately there are people out there who might take advantage of you. Having one person in-house handle the billing and the money could create an unwanted opportunity. Having an outside company handle your claims filing will not completely eliminate this threat. You will still handle the money in-house. However, an independent medical billing company creates another “check and balance”. It is always a good idea to split the responsibilities that involve money between a few people. This is not always possible in-house.

So there you have it. Eight reasons to consider how outsourcing your medical billing can save you money, time, waste and energy.

And yes, I did say there was one reason not to outsource your medical billing.

Letting go can be hard to do
That is it. It is all up to you. Sending your billing outside can feel like you are giving up control, and that is a legitimate concern. If I did not address that here then I would be doing a disservice. After all, your claims are what keep the lights on. It can be scary trusting the most important administration function of your practice to a third party biller.

But you do not have to give up control when you outsource your billing to a medical billing company. When hiring a billing company, ask questions, discuss expectations. Keep good communication with your consultant. Make sure they provide you with reports. A company that files claims using web-based software can give you 24/7 access in real-time to the status of your money.

Physicians are already working harder than ever, and with changes in healthcare coming down the pipe, your burdens are bound to increase. One question you may ask yourself is why have the additional burden of running a billing and collections operation? Many business people today live by the rule - never do anything that you can have someone else do more efficiently and at a lesser cost. Your practice is a business. Could it run more efficient? There are eight things for you to consider. Ultimately, it is your decision.

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Plastic surgery, although often cosmetic in nature and done as an elected procedure, is still surgery. It is critical that you make the decision once you are well informed on all the facts regarding the procedure, the cosmetic surgeon, the facility and how it will effect you.

Ask the right questions, get the right answers. Don’t be afraid to ask the plastic surgeon you are working with as many questions as you need to so that you have no surprises once you have completed the surgery. Also, you want to be very clear on what your expectations are regarding the cosmetic procedure so that the plastic surgeon has all the details to satisfy you.

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1. Know Your Cosmetic Plastic Surgeon. Ask what are his/her credentials and be sure to find out if they are Board Certified by the American Society of Plastic Surgeons (ASPS). It is important to ask what categories they are certified for also. Feel free to verify the information you receive.

2. Plastic Surgery Benefits. Ask what benefits you can expect from your procedure. Some surgeons may have the technology to show you computer generated images of the changes the cosmetic procedure will provide.
3. Plastic Surgery Risks. Ask what the risks are involved in the procedure, recovery and in the future. Surgery is surgery and there will some concerns that you will want to consider prior to having the surgery done.
4. Cosmetic Surgery Alternatives. Ask if there are any alternative to the procedure you are considering. Depending on what the procedure is and what results you are looking to obtain, the plastic surgeon may have non surgical procedures that he offers right in his/her office.
5. The Cosmetic Surgical Facility. Ask where the procedure will be performed and be sure to check out the facility prior to the surgery. Depending on the procedure and the plastic surgeon, you may have the surgery performed in the doctor’s own private surgical suite or in a hospital.

6. Plastic Surgery Costs. Ask right up front what your total costs will be for the cosmetic surgery. In most cases these procedures are out of pocket expenses so you need to know all of the costs up front so there are no surprises later.
7. The Details of the Plastic Surgery. Ask for details! What exactly will the plastic surgeon be doing? What about anesthesia? What about recovery time? What are the long term benefits/risks?

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Healthcare providers are often deprived of their hard-earned income because of rejected claims and inadequate follow-ups. Almost 20% of medical bills go unpaid because insurance companies reject claims based on bureaucratic errors and medical providers give up on the collection. Third party medical billing services firms have the necessary expertise, personnel and technical tools to ensure higher collection of bills, thereby increasing the revenue of medical providers. Following are some of the details a healthcare providers should know of a medical coding and billing provider before hiring it.

Types of Medical Billing Providers

There are many medical coding and billing services in the market vying for clients. Healthcare provider needs to assess their own needs first, and then look for a service that serves their purpose. Most providers offer only billing services; they collect bills by submitting claims accurately and follow up on the payments. Some providers work only for small businesses, which are usually individual setups that offer specialized medical services. Large practice management companies offer comprehensive medical coding and billing packages that include administrative services for running the medical practice effectively.

Policies of the outsourced service providers

A professional medical billing provider follows business practices that ensure high quality of services. Healthcare providers should check the processes followed to ensure effectiveness of the service:

Persistent follow-up of bills

The service provider must follow up on payments aggressively and persistently. Insurance carriers are very fussy and reject or deny claims on administrative technicalities. The provider needs to ensure forms are filled in correctly so that insurance carriers do not get an opportunity to reject them, monitor government programs to ensure accurate payments and pursue all collections with tenacity.

Compliance with regulations

The Health Insurance Portability and Accountability Act (HIPAA) mandates the privacy, security and protection of patient data. Medical coding providers are also privy to confidential patient information, and should comply with HIPAA regulations.

Timely submission of claims

Medical billing providers should be well versed with the process, types of forms and the deadlines for each type of form. Claims must be filed within specified timelines or the insurance company will reject them.

Cost of service

Medical coding and billing service providers charge a flat fee for their services or a percentage of the claim they collect for the healthcare provider. The healthcare provider should examine which fee structure suits them best, and select a service accordingly.

Specialization

Some services providers have a specialty focus in a particular protocol. They promise better collections than general medical coding and billing providers do.

Communication with healthcare provider

The medical coding and billing provider and the healthcare practitioner should communicate openly and clearly to have an effective relationship.

Skills of the workforce

An efficient provider should have trained staff. Healthcare practitioners need to verify the following about the provider’s workforce:

* Are the agents trained in medical insurance coding standards?

* How much experience do the agents have?

* Are the agents updated about changing processes through regular trainings?

* Are the agents familiar with both Windows and UNIX based medical coding and billing systems?

* Does the provider work with employees or contractors? A provider that supports its own staff is preferred.

Technologies adopted by Medical Billing Companies

Providers have a better chance of getting results if they are supported by latest technology and tools. Electronic submission of forms is more effective and less error prone than manual submission. Incorrect forms are one of the main reasons claims get rejected by insurance companies.

Billing services can potentially increase the revenue of medical practitioners by almost 30%. An effective provider frees healthcare providers from the burden of administrative tasks and allows them to focus on patient care.