As the healthcare industry becomes increasingly globalized, some medical diagnostic laboratories are considering outsourcing their medical billing and coding to companies located abroad or domestic companies that have outsourced staff abroad.
While this may seem like a cost-effective solution, it can actually pose serious risks to both your laboratory and your patients. From inaccurate billing and coding practices to compromised patient privacy, there are a number of potential hazards to be aware of when considering a partner for your business.
Do All U.S. Providers Actually Operate In The U.S.?
The answer to this question may seem obvious … if a billing and coding service provider is based in the United States, then your medical diagnostic laboratory would benefit from working with a partner nearby, correct?
Yes and no. While a billing and coding service provider may be based in the United States, it’s important for medical diagnostic laboratories like yours to know that many still outsource the work of their clients to overseas companies.
That may mean that you’ll still feel the impact of working with a non-domestic partner that we outlined above. When searching for a billing and coding service provider, it’s important to determine ahead of time whether that company handles your account in-house or outsources your account to other countries or third parties.
Here are five of the most significant risks associated with outsourcing medical billing and coding services abroad and how you can mitigate these risks by working with a U.S.-based provider.
- Compromised Patient Privacy
- Language and Cultural Barriers
- Lack of Industry Knowledge
- Time Zone Differences
- Difficulty in Resolving Issues
Compromised Patient Privacy
Outsourcing billing and coding abroad can pose a risk to patient privacy. As a medical diagnostic laboratory, you deal with sensitive patient data on a daily basis, including personal and health-related information.
When this data is transmitted to an offshore service provider, it may be subject to different privacy laws and regulations than those that apply in the United States. This could result in a higher risk of data breaches and compromised patient privacy.
For example, some countries may not have as stringent data protection laws as the United States. They may have different standards for the handling and storage of sensitive patient information, which could increase the risk of data breaches and unauthorized access.
Offshore service providers may not have the same level of security protocols in place as domestic providers as well, which could also increase the risk of data breaches and cyber-attacks.
In the event of a data breach, patients’ personal and health-related information could be compromised, which could lead to identity theft, financial fraud and other serious consequences. This could damage the reputation of your medical diagnostic laboratory and result in legal and financial consequences.
It’s important to carefully evaluate the potential risks and benefits of outsourcing your billing and coding abroad and take steps to ensure that patient privacy is protected at all times. This may include working with offshore service providers that have strong security protocols in place or implementing additional safeguards such as encryption and secure file sharing.
However, your legal recourse outside the country is significantly limited since U.S. laws only pertain to companies operating in the United States. It is in your best interest legally to work with a company that is located domestically to protect your business and ensure legal recourse should you need it.
Language And Cultural Barriers
Language and cultural differences can create significant barriers to effective communication between your medical diagnostic laboratory and a billing and coding provider abroad. This can ultimately result in errors and misunderstandings in billing and coding practices.
For example, if the offshore service provider’s team members are not proficient in the same language as your team members, communication can be challenging. Miscommunications can occur, especially when discussing complex or technical information related to billing and coding practices.
Cultural differences can even make communication difficult. Different cultures may have different communication styles, norms and expectations. This can lead to misunderstandings, confusion and offense if team members unintentionally violate cultural norms or expectations.
Even if the provider’s management is in the U. S., but they have outsourced staff abroad, waiting for the management team to communicate with offshore outsourced contractors can create the same issues.
Lack Of Industry Knowledge
U.S. regulations that govern healthcare billing are complex and subject to frequent changes, so having a team that is knowledgeable and up-to-date on the latest rules can ensure that your medical diagnostic laboratory remains compliant.
Add to that the fact that many laboratory services are performed out-of-network for insurance companies, and your laboratory’s billing and coding needs become more complicated.
A service provider based overseas or with offshore staff may lack the industry-specific knowledge and experience required to effectively manage billing and coding practices for your medical diagnostic laboratory. This lack of familiarity with these regulations can lead to compliance issues that could result in penalties, fines or even legal action. Not to mention delays in getting paid.
In the United States, medical coding is primarily performed using the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) code sets, which are maintained by the Centers for Medicare and Medicaid Services (CMS). However, other countries may use different coding systems or have different rules and regulations around medical billing and coding.
Offshore service providers that lack industry knowledge of the specific coding requirements and regulations in the United States may struggle to optimize billing and coding processes, resulting in errors, delays and inefficiencies that could impact patient care and lengthen the time it takes for your company from receiving the money you are owed.
Time Zone Differences
If your medical diagnostic laboratory already works with an overseas billing and coding provider, you may have already faced challenges related to time zone differences.
In today’s digital age, many medical businesses work with partners located around the world to provide the best care to patients. However, with billing and coding duties, these time zone differences can provide significant challenges that can impact processes and communication between your laboratory and the offshore provider. These challenges can ultimately affect patient care.
For example, time zone differences can create delays in the processing of billing and coding requests. If your provider is located in a time zone that is ahead of your laboratory, it may not be possible for your lab to receive timely updates on the status of billing and coding requests or to provide feedback on errors or issues. This delay in processing could impact your laboratory’s ability to bill for services and receive timely payments.
Time zone differences can also create communication challenges between your lab and billing and coding services provider. For example, if an overseas provider is located in a time zone that is significantly different from yours, it may be difficult to schedule conference calls or video meetings at times that are convenient for all parties. This could make it challenging for you to provide feedback on billing and coding processes or to collaborate with the offshore provider to resolve issues.
Difficulty In Resolving Issues
If a billing or coding error occurs, it can be difficult and time-consuming to resolve the issue with a billing and coding provider located in another country or with staff abroad. Distance, language barriers and time zone differences all impact the ease of resolving important billing and coding issues, and in the end, you may face additional problems you’ll have to deal with as a result.
Difficulty resolving issues can have a significant impact on the payment cycles of your medical diagnostic laboratory, which could ultimately increase frustration for both you and your patients. For example, if an offshore service provider makes a coding error that results in a claim denial, your laboratory may need to spend additional time resolving the issue and resubmitting the claim. This delay in payment can impact your cash flow and revenue cycle, leading to longer payment cycles and potentially affecting your ability to provide timely services to your patients.
This impact could be felt even further. If your lab is not receiving timely payments for services rendered, it may have difficulty investing in new equipment or technology that could improve patient care. And, if patients are frustrated with your laboratory’s billing practices, they may be less likely to return for follow-up appointments or recommend the laboratory to others.
Benefits Of Working With A True U.S.-Based Partner
Working with a U.S.-based medical billing and coding service is the solution you need for your medical diagnostic laboratory to stay on top of the billing and collections process, reduce administrative costs, and ensure timely and accurate claims submission.
Benefits include:
- Better patient privacy since U.S.-based companies must follow domestic privacy laws
- No language or cultural barriers since all billing and coding services are handled in-house
- Increased industry knowledge since high-quality U.S-based billing and coding service companies are familiar with the unique requirements and regulations that govern healthcare billing in the United States
- No extreme time zone differences
- Better outcomes with resolving issues due to the above benefits
Professional medical billing and coding companies invest in the latest technology and tools to help their clients manage the billing process efficiently and accurately. By partnering with these companies, you can benefit from the latest technology without having to invest in it yourself.
Some of these tools include:
- Electronic Health Record systems
- Practice Management software
- Revenue Cycle Management software
- Compliance Monitoring tools
U.S.-based medical billing and coding experts have a deep understanding of the complex billing and coding regulations and requirements in the United States, as well as the latest trends and best practices in the industry.
By partnering with experts in the field of medical billing and coding, you can benefit from this industry knowledge, improve the accuracy of your billing and coding processes, and avoid the five risks we outlined above.
