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Is It Profitable to Outsource Medical Billing in 2022?

One of the pillars of a thriving practice is medical billing and how they deal with that particular task. Most practices maintain an in-house operation, using top contributors and employees, regardless of their talents, skills, or for that matter capability to deal with this necessity. This limits their resources and possibly mismanages skill-sets. For a practice to achieve any level of success, it needs to properly manage its workers, maintain a responsible hierarchy of chores, and basically direct manpower where it will be put to better use — in essence, streamline the operation. That’s why many are dawning on the benefits of outsourcing medical billing for healthcare organizations. On having outside organizations, with better sources, better know-how, and better tools handle that particular bureaucratic swamp.

In this article, we’ll talk about the differences between in-house and outsourced medical billing, the cost of outsourcing medical billings, and other critical issues regarding this practice.

What is outsourced medical billing?

Outsourced medical billing is a process in which medical providers can hire outside help, from third-party vendors and services for their medical billing — most often with organizations that specialize in it. It is a great and highly affordable way to optimize their finances, and revenue flow, making it more efficient and accurate. It is not only incredibly affordable, with different services and cost depending on your needs, but if conducted correctly it can not only foolproof your profits, but also patch up some of your organization’s weak points — safeguarding you against medical billing vulnerabilities, such as denied claims or clerical errors, and mitigate some of your risks.

One of the main reasons why most organizations are jumping on the bandwagon and hiring out services for their medical billing requirements is because providers are not trained on how to do this, and typically don't have the time to do it.

One of the main benefits of these services is that the billers work directly with insurance companies, they will be able to get paid faster than if the provider - your practice - presented the bill.

Outsourcing medical billing — how to

Outsourcing medical billing is a process of transferring medical billing functions to a third party. This process can be done in various ways. Many companies offer outsourcing services for medical billing, but there are three major ways to meet the challenge. These are:

Hiring an agency to handle all the work.
Hiring an individual.
Hiring an overseas company.

Today, the most advantageous option is to hire a company with a reputation. One that has lines of entry with most insurance companies and has already established with the powerhouse a positive, dynamic, and lucrative relationship.

How are outsourced medical billing services usually paid?

Outsourced medical billing services can be paid in the following ways:

Hourly: The most common way for outsourced medical billing services to be paid is hourly. When this is the case, the service will charge their clients for a certain number of hours of work.
Flat fee: Some outsourced medical billing services charge a flat fee for their work. This means that they will get paid no matter how many hours they spend on the task.
Per claim: Some outsourced medical billing services charge per claim, which means that they will get paid when they successfully process that claim.

The cost of outsourcing medical billing

Medical billing outsourcing has been adopted by many healthcare providers as a cost-effective way of managing their billing. However, there are some disadvantages to this approach as well.

One of them is the fact that you will have to pay for a service which up until this moment you were handling in-house.

Another disadvantage is that unless you hire a certified service, one with years of experience, you will have to implement security features to maintain control of private patient files and personal business data. Why? Because over the long run you are exposing this data to outside suppliers — which, in turn, exposes you to liabilities. This is only an issue if practices don’t hire a certified service — those already have strong security features and powerful firewalls and security policies.

Factors that influence the cost of outsourcing medical billing

Medical billing is a complex process that requires a lot of attention to detail. It is also a time-consuming process which makes it difficult for providers to do it themselves or hire someone locally who can do the job. This is why so many providers outsource their billing to third-party vendors, such as medical billing services, who specialize in this area.

The cost of outsourcing medical billing varies depending on the factors that are involved. These include the type of medical provider (e.g., hospital vs. private physician), the size and complexity of the practice, and whether or not you need additional services like coding, transcription, and patient care coordination which can all add additional costs to your billings.

Benefits of outsourcing medical billing

When considering the cost of outsourcing medical billing it’s important to also tabulate the advantages you are acquiring with said service — create a cost/benefit spreadsheet. It may spook some organizations the idea of moving such an integral part of their practice off-site, but it’s also important to grasp what you’re getting in return.

Faster payments: most billing services work or have a very intimate relationship with insurance companies this means they can get you paid faster.
Automation; most services work with automated tools. In most cases, this helps in managing your payments and getting them into account faster.
Certifications: most services work with certifications. What does that mean? It means that due to their prior success in properly filling in papers with insurance companies, they’ve already been vetted by that industry — this translates to more accurate paperwork and less scrutiny by agents and AI software once filed.
Training: you won’t have to train your staff.
Up-to-date: if there are any changes in legislation, in the overall red-tape of medical billing, in medical, in compliance, in coding, in transmitting claims, or any other of the essential steps of the process, the service automatically updates their practices and platforms.
Shift -Left: in software development, it's called shift-left, when a challenge is tested and carried to the end-zone right from inception. In a way this is one of the main benefits of outsourcing medical billings — these kinds of services also work on that principle, they are activated the minute a patient enters your practice, they start filling out claims, checking insurance papers, and generating everything from the word go, right at the beginning.

These are just some of the benefits of outsourcing your medical billing process and also why this type of service is fast becoming mainstream — hundreds adopting it into their infrastructure. Overall, it makes medical practices more efficient, more compressive when it comes to their finances, and more competitive.