Medical billing – When to Outsource?

Medical professionals continue to struggle with ever changing reporting requirements. As the healthcare industry moves towards performance driven reimbursement it is likely to continue to grow. However, outsourcing billing is not an immediate answer. Electronic documentation with the aid of EMRs has moved things in a positive direction as it drives evidence based documentation and simplifies data transmission between providers and payors. With almost 57% of office based practices now utilizing EMRs, medical errors are likely to reduce over time which should result in more accurate documentation and reduced number of denials.

While completeness of documentation carries importance, most practices are able to improve returns by maintaining a consistent relationship with payors. An efficient billing team is likely to remain on top of changes in regulations and payment criteria which results in better claim management. Claims are likely to be denied on the basis of errors in medical billing and coding or if services rendered are not covered or considered as irrelevant. However, with regular analysis the billing team can identify risks and create an appropriate plan through continued learning of the practice.

Account receivables need to be consistently monitored. Most practices choose to utilize the aging scheme method by pooling accounts of a certain age and devising an age specific strategy. Different follow-up standards could be devised based on the materiality of the amount owed and the age of the receivable. If the account is due over 120 days, there is a good chance its due to an error either by the practice or the insurance company. Almost 19% of the claims denied can be attributed to errors by the insurance company.

An age of 120 days is unfortunately common for providers, as almost 10% of accounts receivables for most practices are likely to be above that figure and have to be written off as bad debts. Medical billing companies are slightly more aggressive in their approach, which can sometimes pay off where internal billing has been inefficient. Practices suffering from aged accounts are likely to gain more by outsourcing to an efficient medical billing service especially since most medical billing companies charge their clients based upon their collections.

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