7 Reasons Why You May Need To Outsource Medical Billing Now

Whether your practice is facing financial strain, grappling with regulatory changes or working to enhance patient care, you’re not alone if your practice is constantly struggling with navigating the complex U.S. healthcare system.


Yet, amidst these challenges, there is some hope. Medical billing services can offer a strategic solution that offers benefits NOW and long-term advantages in the future.


Here are seven reasons why your practice may need to outsource medical billing now:


  1. Your organization is experiencing financial strain
  2. Your practice’s workload has increased
  3. You want to save on costs
  4. Billing and coding regulations are challenging to keep up with
  5. You need scalable services
  6. Your practice lacks the necessary technology infrastructure
  7. You want to focus more on your patients



Your Organization Is Experiencing Financial Strain



Financial strain within a medical practice, hospital or laboratory can comeoutsource medical billing from various inefficiencies in billing processes. One critical aspect contributing to this strain is the potential for miscoding or inaccuracies in coding medical procedures and services. 


Incorrect coding, whether intentional or unintentional, can result in underbilling or overbilling, leading to missed revenue opportunities or potential legal consequences if billing errors are identified during audits. Missed opportunities to code for billable services can result in lost revenue, further exacerbating your practice’s financial strain.


Another factor contributing to financial strain is how many claim denials your office experiences. Claim denials can happen to anyone. In fact, research shows that nearly 20% of all medical billing claims are denied. But when they’re happening on a regular basis, it’s important to take the steps NOW to reduce them. 


Denials occur when insurance companies reject claims for reimbursement due to errors or discrepancies in the billing process. Common reasons for denials include:


  • Incomplete or inaccurate patient information
  • Lack of preauthorization for services
  • Coding errors
  • Failure to meet other billing requirements


Each denied claim represents a lost revenue opportunity and requires additional time and resources to rectify and resubmit, delaying payment and impacting cash flow.


By outsourcing medical billing, you can begin to mitigate the risk of financial strain caused by coding inaccuracies and claim denials. Professional billing companies employ skilled coders and billing specialists who are trained to accurately code medical procedures and services according to industry standards and regulations. 


They also have systems in place to identify and rectify coding errors before claims are submitted, reducing the likelihood of denials and ensuring timely reimbursement for services rendered.


Your Practice’s Workload Has Increased



If your practice’s workload has increased, that’s a good sign that your office is growing. However, this also may mean that you need to look for solutions to provide immediate support to handle the additional workload without overburdening existing staff. 


If you’re a small medical practice and you have a medical billing manager who currently handles medical billing, outsourcing some of your services can help relieve the burden on your manager who is likely dealing with a heavy workload. 


It’s also possible that your staff’s workload has increased if you’re facing staffing shortages due to turnover, illness or other reasons. Outsourcing medical billing can provide a faster solution to alleviate these issues without interrupting billing operations. 


Even if you have the financial capacity to hire additional staff members, you’ll need to take into account the time it takes to train and get all staff up to speed on billing procedures in your office.


You Want To Save On Costs



Cost savings are an important consideration for any business oroutsource medical billing organization, including healthcare practices. Outsourcing medical billing presents an immediate opportunity to reduce operational expenses. 


Maintaining an in-house billing department entails substantial costs, including salaries for billing staff, expenses associated with training and continuing education, investments in billing software and technology, and the ongoing maintenance of billing infrastructure.


By outsourcing medical billing, your organization can reduce costs associated with hiring personnel and benefit from significant cost savings in other ways. Rather than bearing the financial burden of hiring and training billing staff, you can leverage the expertise of external billing companies that specialize in revenue cycle management. 


These companies employ experienced billing professionals who are knowledgeable about medical coding, billing regulations and insurance claims processing … reducing the need for extensive training and supervision within your practice.


Outsourced medical billing services can operate on a pay-per-service model where your organization only pays for the specific billing services you require. This approach eliminates the need to maintain a full-time billing department with fixed overhead costs, including salaries and benefits. Instead, your practice can access billing services on an as-needed basis, optimizing resource allocation and maximizing cost-effectiveness.


Billing And Coding Regulations Are Challenging To Keep Up With



Staying compliant with ever-evolving billing regulations and coding requirements poses a significant challenge for healthcare organizations. Medically, coding guidelines are typically updated each year. 


Regulatory changes, whether at the federal, state or insurance company level, can impact billing practices and reimbursement rates, making it essential for organizations to stay on top of these updates. 


However, keeping up with regulatory changes requires continuous education and training for billing staff, as well as ongoing monitoring and adaptation of billing processes.


If recent regulatory changes have been implemented and your organization’s staff are not adequately trained to navigate these updates, outsourcing medical billing to experts can provide immediate relief and ensure compliance. 


As we talked about above, failing to adhere to regulatory requirements can lead to claim denials, delayed payments and potential legal consequences, all of which can negatively impact the organization’s financial health. By outsourcing to experts who stay up-to-date with regulatory changes, healthcare organizations can minimize the risk of non-compliance and prevent revenue loss associated with billing errors.


You Need Scalable Services



Certain types of healthcare facilities may be more likely to experienceoutsource medical billing fluctuations in patient volumes and can benefit from scalable billing services.


For example, urgent care centers often experience fluctuating patient volumes based on factors such as time of day, day of the week, and seasonal variations in illness and injury rates. Scalable billing services allow urgent care centers to adjust their billing operations to accommodate these fluctuations without overstaffing or understaffing their accounts receivable or billing departments.


Primary care practices may even see variations in patient volumes due to community health trends and changes in population demographics. 


Most recently, during the Covid-19 pandemic, telemedicine practices experienced great fluctuations in patient volumes. Changes in healthcare regulations and shifts in patient preferences for virtual care may continue to change the demand for these online services.


The ability to adjust billing services according to fluctuating demand can help you maintain operational efficiency and financial stability. Medical billing companies offer immediate scalability options that can address the organization’s current needs and accommodate future changes without the need for extensive restructuring or workforce adjustments.


Your Practice Lacks The Necessary Technology Infrastructure



Technology plays a crucial role in optimizing billing processes and maximizing revenue capture. However, many healthcare organizations may lack the necessary technology infrastructure or software to efficiently manage billing operations. 


In these cases, a medical billing outsourcing company can offer advanced billing technology can provide immediate access to the tools and resources needed for streamlined billing operations.


Outsourcing medical billing to a reputable billing company offers healthcare organizations like yours access to state-of-the-art billing software and technology platforms without the need for significant upfront investment. 


Medical billing software programs can range in price depending on the services you need and the size of your medical practice. Some software starts as low as $65 per user per month and goes as high as $600 for a single user per month. 


For more advanced hospital systems and healthcare companies, you can expect to pay thousands per month, with some estimates reaching $15,000 to $30,000 per month. This ultimately can impact your bottom line and impact your ability to save money, even if you have several revenue streams at your practice.


These advanced technologies are specifically designed to streamline billing processes, improve efficiency and enhance revenue capture, ultimately leading to increased profitability and financial sustainability for the organization.


Advanced billing technology platforms also often feature intuitive interfaces, automation capabilities and built-in error detection mechanisms that help minimize manual data entry errors and ensure billing accuracy. They may include advanced reporting and analytics functionalities that provide valuable insights into billing performance, claim status and revenue trends, allowing your organization to make data-driven decisions to optimize your financial operations.


It’s also important to note that advanced billing technology can help protect your medical facility and patient data against the risk of data breaches. During a breach, your patients’ medical records or confidential information can land in the wrong hands, and ultimately, you will have to answer to your patients for the breach. 


Outsourcing medical billing to a company with advanced billing technology enables your practice to stay up-to-date with the latest industry trends and regulatory requirements without paying the full costs of a software license.


You Want To Focus More On Your Patients



Outsourcing medical billing offers you a valuable opportunity to redirect your focus toward your core activities of patient care and clinical services. Rather than expending time and resources on billing tasks, you can entrust these responsibilities to external experts, allowing them to devote more time and attention to delivering high-quality care to your patients.


The demands of medical billing, with its intricate coding requirements, complex insurance regulations, medical credentialing and time-consuming administrative tasks, can often detract healthcare providers from their primary mission of improving patient health outcomes. 


By outsourcing medical billing to specialized billing companies, healthcare organizations can alleviate this administrative burden and enable their staff to concentrate on what they do best – providing compassionate and effective patient care.


Outsourcing medical billing not only frees up healthcare professionals to focus on patient care but also enhances overall efficiency within the organization. With billing tasks handled by dedicated experts, healthcare providers can streamline their operations, reduce administrative overhead and optimize resource allocation. This allows for a more seamless and coordinated approach to patient care delivery, ultimately leading to improved patient satisfaction and outcomes.


Medical billing specialists are well-versed in the intricacies of medical coding, billing regulations and insurance claims processing, ensuring that billing tasks are completed accurately and efficiently. This not only reduces the risk of billing errors and claim denials but also maximizes revenue capture for the organization, contributing to its financial stability and growth.


In other words, outsourcing medical billing empowers healthcare providers like you to refocus your efforts on your core activities of patient care and clinical services while benefiting from the expertise that medical billing and coding companies offer.


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