Is Outsourced Billing for You?

Is Outsourced Billing for You?

With the technology advances in this day and age, the previous way of hand billing for claims has taken a back seat to outsourced billing. So how do you know what is the best for your company? The following will list some considerations to make when determining what is right for your organization.

What is the size & type of your company?

Many small healthcare businesses can use in-house billing and be successful at it, but that can be a more daunting task for a large company. At times, larger companies have a more difficult time providing oversight for billing services than the smaller companies. This lack of oversight can cause financial hardships because of lost revenue.

The type of healthcare company can also play a part in the decision to outsource. Specialty care companies such as those providing anesthesiology would get the greatest benefit from outsourced billing because, oftentimes, they provide services in multiple places which can cause billing confusion. Outsourced billing companies’ websites such as inform potential clients of the availability and effectiveness of outsourced billing services.

Outsourced Billing

Decrease in Reimbursement

There are many times that a company does not even realize that there are billing problems until revenue starts dropping. This decrease in reimbursement is almost always tied to a form of billing inconsistencies. These issues can range in seriousness topping out at some form of fraud being committed, and often that fraud can be innocently committed. The in-house biller can become comfortable in the position and not watch the system as closely as it should be causing incorrect billing which in turn can contribute to money not being collected or even money being recouped. Small drops in reimbursement can snowball very quickly and be the first sign of major problems to come.

Difficulty retaining billing personnel

Staffing turnover is a problem that most all healthcare companies encounter, and billing is not an exception to that. Sometimes, an in-house biller is great but then he or she gets ill, goes on vacation, or is away from the workplace for some other reason, so what happens to the billing claims that need to be filed? Or an even worse case is that a company has a difficult time retaining billing personnel and the position is a revolving door.

This alone will cause serious problems for a company because claims can miss timely filing or be filed incorrectly. When an outsourced billing company is used it becomes that company’s responsibility for staffing issues and because that is what they specialize in they have many more resources to utilize from a staffing aspect. It is their responsibility to ensure that your billing process is never hindered by personnel issues.

Difficultly keeping up with billing regulations and changes

As any healthcare-related company knows, rules and regulations are constantly changing. It can be difficult for a company to keep its billing personnel educated on all of these changes. Many companies do not require licenses or certifications for billing personnel, which would necessitate annual education of some kind. Instead, in-house billers are expected to keep themselves abreast of the latest regulatory changes.

It can be expensive for the company to pay for the education, but it would almost be necessary for in-house billing personnel because, without it, fraudulent and inaccurate billing problems could become a serious problem from simply not knowing the regulation.

Not being knowledgeable of changes will not be an acceptable excuse in the case of appealing potential recoupments. However, companies that specialize in billing can ensure that every biller they employ stays current with all rule and regulation changes. That is their business to make sure that the client’s billing is done correctly per all regulations.

Recoupment of money

Most all payor sources, both governmental and private, are constantly reviewing billing claims to look for imperfections and inaccuracies. These findings allow them the opportunity to request additional documentation, referred to as an Additional Documentation Request (ADR), and recoup a part of the payment and at times all of the payment until the matter is resolved. Governmental payor sources such as Medicare have the ability to suspend billing privileges if there is enough money recouped.

Companies are given the chance to refute and appeal recoupment decisions, but because of the amount of time the process takes and a knowledge deficient regarding how to respond at times, these appeals are not submitted in a timely manner, not submitted at all, or not found favorable enough to reverse the recoupment.

Many times, the errors that are triggering this recoupment process are not being done purposely but rather for lack of knowledge. If this is something that your company is having a problem with, it may be time to reach out to a medical billing company. These companies stay abreast of the latest trend in these types of cases because they see them day in and day out. They know before ever submitting a claim if there is a possibility of it triggering a review and, when that happens, they also know the proper way to respond and appeal to get favorable decisions.

Pros of outsourced billing

So, what are some of the takeaways for the pros for a health-care company to outsource its billing?

  1. Certified or licensed billing personnel
  2. Billers are educated and knowledgeable of current changes in regulations and billing trends
  3. Assistance with recoupment proceedings
  4. Staffing issues do not have to be rectified by the company
  5. Consistent billing is performed and timely

Healthcare companies are just like any other proprietary or non-profit and must have an adequate and consistent revenue source to be successful. Regardless of whether exceptional care is given to clients, if the billing portion of the company is not functional, the company will have problems. That, in turn, can spill over into patient care. Perhaps some companies are functioning positively with their current billing processes, but many know there are deficiencies. If that is the case, it may be time to seek outsourced help.

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