The task of getting claims paid has always been a challenge, but it seems that these days it's getting worse. Every time you think you figured out all of the tricks that payers use to avoid paying claims, the rules change and you have to figure out a new set of tricks. This is a full-time job. But in many smaller practices, the job of medical billing is just one of the tasks that an individual may be responsible for. Often, in-house medical billers are also responsible for answering phones, scheduling appointments, assisting in patient care, picking up dry cleaning—well, you get the idea. Interruptions in the billing process often lead to errors that slip through and cause rejections and denials, which creates more work.
An increasing number of independent medical practices are turning to medical billing services to alleviate some of the burden of getting claims paid. If you are considering this option, here are some ways that outsourcing your billing may benefit your practice.
Improved Billing Processes
One of the biggest benefits of working with a billing company can be having access to more experienced billing personnel. In a small practice, the job of billing is often delegated to someone who has not necessarily been trained in medical billing and coding, so they tend to have to figure things out as they go. This can cause an increase in preventable denials which often go unworked due to time constraints and interruptions. Medical billing companies employ specially trained staff who often work with multiple practices and are able to use the knowledge and experience gained to benefit your practice.
According to the Medical Group Managers Association (MGMA), medical practices typically see 10-15% of their claims rejected or denied on the first pass. It is estimated that up to 50% of these claims are never corrected and resubmitted. The revenue lost due to unworked denials adds up quickly. Just one unworked denial a week can result in over $5000 in lost revenue in a year. This is assuming an allowed amount of only $100 per claim. In specialty practices where the average reimbursement for a visit is higher, this lost revenue can reach $10,000 or more a year. In most medical billing companies, dedicated staff are tasked with working denials and making sure that every claim possible is paid.
Just one unworked denial a week can result in over $5,000 in lost revenue in a year. For specialty practices with high allowables, the loss can be $10,000 or more.
Reduced Administrative Burden
Outsourced billing allows small practices to function more efficiently with a smaller in-house staff focused more on patient care and less on administrative duties. Rather than your staff spending time posting charges and payments and chasing down unpaid claims, they can spend more time engaging with patients to provide a better experience. In some cases, you may even be able to reduce overhead by utilizing less physical space for your office or expand your practice to see more patients or provide additional services.
While outsourcing billing may not be the answer for every medical practice, it offers many benefits to practices that are experiencing growth spurts, have difficulty finding and retaining qualified billing staff, or simply don’t want to be bothered with the administrative burden and would rather focus on patient care. It’s worth taking some time to evaluate your current processes and find out what options are available.
If you think that outsourcing your medical billing might be something to consider, please join me for a webinar on Financial and Operational ROI for Outsourcing Your Medical Practice Billing.
We will cover ways that you can assess your current billing process to determine what improvements you might see by outsourced billing. And I'll provide some tips on determining what type of billing company you need and what services you can expect them to provide.