ObGyn Billing Services in Texas: In-house or Outsourcing?


Obgyn billing services in texas

The debate on whether to choose in-house billing or outsourcing ObGyn RCM depends on a multitude of factors such as practice, time the business has been around, market size, and finances. As ObGyn billing and coding is the most crucial and complex constituent of a medical practice, factors need to weigh appropriately before an action is taken on choosing the service. Again, due to newer and constant innovation of technologies, drugs and codes, and government regulations, practitioners need to often choose which service will work best for them. Moreover, the management style of the practitioner/healthcare center tends to be an important aspect in deciding between the two options.

So what do these alternatives imply?

In-house billing refers to the billing and coding done by the staff of the practitioner/healthcare center i.e. all aspects of revenue cycle management such as insurance verification, patient registration, coding, submission of claims, and collections from insurances and co-pays and managing A/R’s which are handled by the employees. It could be a separate department in a larger centers or the work overlaps between the administrative staff in a solo practitioners’ facility. In the case of outsourcing, a company is hired to take care of all the billing needs which charge a percentage of the collections or a fixed fee. However, it is imperative that the costs are evaluated before the work is given to the outsourcing company (costs should ideally be around 5-10% of the total revenue earned).

Pros and cons (in-house billing):

1.      Accessibility: As soon as a patient visits the facility, insurance verification is possible spot on, and charges can be entered in the system leading to faster claims and payments by the staff. The physician can also have quick access to financials, such as past-due patient accounts, along with other expenses and revenues being traceable.

2. Competency: Once the physician/healthcare center has recruited a billing team, education and trainings continue along with the possibility of accurate and timely billing services. A competent billing manager will be able to provide regular guidelines and ensure that the staff is updated on the constantly changing codes and billing regulations. He can also handle all the issues related to the software and technology.

3. Proximity: In-house billing gets easier if documentation or codes need to be re-checked by a physician, which can be then done instantaneously. Sometimes, due to this proximity, the physician has a better control over every aspect such as scheduling, purchasing and finances, and the patients details remain confidential.

4. Few staff: However, is the billing team is small and someone is absent (vacation/illness/quits), the operations can get disrupted and the revenues can decline if another competent personnel is immediately unavailable and/or is not being recruited at the earliest, and the work load increases. And if the billers are not competent, it can create a serious dent in the cash flow.

5. Expensive: In-house billing can be expensive as physicians have to pay for employees’ salaries, allowances and medical insurance along with other billing setup costs (technology, coding, execution).

Pros and cons (outsourcing):

1. Costs: Costs related to office space, investments in software and hardware, billing personnel and their salaries, health insurances, seating and storage space, training costs etc. are avoidable.

2. Staffing: There are no worries about staffing as replacements are available at all times. And as the billing is being taken care of by competent and certified billers, it leads to lesser denials on claims, along with the outsourcing company having the ability to figure out and fix the reasons for denials. Again, as the billing and coding personnel are experts in ICD-10 as well as other specialty codes, they tend to garner the most accurate and timely reimbursements.

3. Reports: If the medical company provides performance reports, the outsourcing company can automatically gain visibility of their billing operations.

4. Regularity: The ObGyn outsourcing company is more consistent in terms of accuracy, timing and regularity in sending claims and their follow-up. They are also able to identify denials and other reimbursement trends.

5. Control: Physicians who prefer to possess complete control and monitor operations may not fancy this option. Also, if service fee is not set and depends on revenues, it tends to create issues as the billing budget varies and costs fluctuate widely. Also, add-on services such as cancellation fees, printing reports, sending of added claims and emails etc. can end up costing more.

A cost-benefit analysis of requirements must be done before ObGyn physicians/healthcare centers opt for the best fit.

Posted in Accounts Receivables, Claims Denials, EMR / EHR / Health IT, Health Insurance, Healthcare Reforms, ICD-10, ICD-10 Coding, ICD-10 Testing, Medical Billing, Medical Billing & Coding jobs, Medical Coding, Medicare Medicaid, OB Gyn Billing, Physicians/ Doctors, Practice Management, Revenue Cycle Management (RCM) | Tagged , | Leave a comment

7 step approach to increase your practice’s revenue


In our previous blogs, MBC has highlighted ways in which you can focus on the health of your patient and yet manage to deliver error free claims and reduce your medical billing costs just by outsourcing your billing revenue cycle. The new rules and regulations introduced by the Accountability Care Act (ACA) have led to a host of administrative and operation complexities in the medical practice. This inevitably leads to higher investment in not just trained staff that keeps updated about the regular updates introduced by the CMS but constant upgrades for software and hardware. This leads to misdirection of attention to such overheads rather than focusing on Patient Care- your passion. Further, for smaller practices, the introduction of Value-based care is impacting the revenues of healthcare providers who need to ensure they receive every dollar earned while giving quality patient care.

Here we provide a 7 step approach that can help you keep your focus centered, i.e. patient healthcare, and yet align your practice towards increasing your revenues while minimizing certain expenses and the risk of reimbursement loss.

  1. Vigilant Patient Verification & Eligibility:  This is very essential as even a tiny spelling mistake will have the payer rejecting or denying the claim. Ensure that all patient details are checked as per payer forms and their insurance details upfront. Moreover, if the patient is not covered by the payer, could mean loss of revenue for your practice. This is time consuming and can take a lot of effort. Either providing a checklist to your staff or outsourcing the verification and eligibility could help you save a lot of not just time but even dollars.
  2. Maintenance of Electronic Health Records (EHR): Healthcare authorities are now insisting on meaningful use of EHR, a tool which helps to effectively manage patient medical records for security as well as helping to devise healthcare plans. This also aids in minimizing documentation issues and errors. The need to invest could prove costly both in terms of operation as well as administrative (training staff and software upgrades). But when outsourced that part is taken care of and hence streamlined and also helping meet government compliance.
  3. Stringent Billing & coding: Even a small coding error can mean diminished returns as the claim will be either denied or rejected. Moreover, CMSs constant changes in the introduction of new codes and modifiers, requires a knowledgeable staff and efficient systems. Moving towards an integrated end-to-end system that integrates both the front and back office data flow, provides seamless workflows, and streamlines the coding and billing process integrated with the practice management process will ensure a healthy cash inflow.
  4. Enhanced Practice Management:  For any healthcare provider, the need to put into place a practice management process is very essential. Practice management system not only help to furnish basic reports like days in A/R aging by payer or the productivity of individual providers, but can also help managers why certain kinds of claims have been denied, which health plans present consistent problems in certain areas, or why claims get held up when they’re being prepared and validated. By streamlining this process, and integrating it with the  and the RCM process, ensures a much more efficient way to ensure that your revenues continue to flow and rectify discrepancies when detected.
  5. Effective Revenue Cycle management (RCM):  This is the most critical of all processes to ensure that revenue is not lost. It involves claims processing, payment and revenue generation, and now entails the use of technology to keep track of the claims process at every check point. It is a known fact, as per the Medical Group Management Association (MGMA), that nearly 50-65 percent of denials go unclaimed. This means that not only are you missing out on revenue, but also on the chance to spot denial trends and prevent future occurrences. Resubmission of claims means loss of dollars in your cash flow as it costs an average of $25 per claim for the resubmission process. Imagine, just 50 denied claims means a loss of $1,250 in administrative costs alone. According to a report from Micro Market Monitor, the revenue cycle management market is currently valued at $20.5 billion and is estimated to reach $40.4 billion by 2021, at a developing CAGR of 12.0 percent from 2016 to 2021. Errors in revenue cycle management can result anywhere between a 3 percent to 5 percent loss of revenues in hospitals/clinics. It is thus advisable to outsource the RCM to concentrate on patient health.
  6. Improved Automation of Accounts/Receivable: This is the key to having an efficient and effective healthcare practice. It has been recorded that nearly 26 percent of self-employed doctors and 35 percent of those employed in the healthcare industry spend 10+ hours per week on paperwork and administration! Moreover, automation can help provide an error free claims process- as once data of the patient has been correctly entered, then processing later will be hassle free as automatic updates to your system will be available with respect to not just verification but also insurance eligibility. Moreover, automation in coding and billing can help increase the efficiency and decrease the chances of claim denial and thus make effective the Accounts Receivable (A/R) process. Practices whose receivables are past due over 90 days means a loss of revenue and when this process is automated the issues can be addressed to shorten the payment time frame and prevent similar problems in the future.
  7. Scrupulous Compliance: Being compliant in today’s medical practice can save you dollars. The number of reports that need to be submitted online and meeting the auditing compliance process, is very essential that your practice does not get hauled up for waste, abuse or fraud and thus avoid costly and inconvenient potential legal pitfalls.

Healthcare providers who follow the above 7 step approach, and strategize on either outsourcing the entire medical billing and coding process or just their Revenue Cycle Management (RCM) or Electronic Health Management (EHR) process will definitely see revenues increasing due to a more efficient process that can be integrated with in-house systems and processes.

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How Important is Error-Free Claims Processing to Improve Profitability of Your Practice?


Free Claims Processing According to research sources, poor medical billing practices in the US alone are estimated to leave approximately $125 billion on the table each year! The reasons for this can be embedded in an inefficient Revenue  Cycle  Management  (RCM)  process,  which  begins  right  from  the  front  desk  verification  of patient’s insurance documents, through the proper coding and billing cycle, submission of  the claims, follow-ups of the claims with insurers and the resubmission if rejected and or denied the claim. It is this claims process that is most critical to any medical services or healthcare provider and can have a major impact on their financial performance.

Imagine the consequences on the profitability of your medical practice if you experience a claims rejection rate of 10 percent on just the first pass! And, what could ensue for complex patient visits, if the rejection rate climbed higher? On an average, a claim refilling costs up to $25 per claim (few industry sources put an even higher figure), which can make claims adjudication a very expensive proposition. Hence, the better optimized your claims submission workflow process is, the better your first-pass payment rate, and the shorter your billing cycle will be. Sources have also estimated that for group practices the benchmarking average rejection rate is approximately 5-10 percent.

Reports have estimated that up to 80 percent of medical bills contain errors. These errors could be as minor as a misspelling of a patient’s name, not verifying if the patient is eligible as per the insurance coverage to even a transposition of a code digit. Every person on the staff needs to be vigilant about whatever has been entered into forms- more the automated ones as the mistakes can carry forth and bypassed very easily. Even the physician’s documentation needs to be clear and precise for the coders and billers to easily verify and make the appropriate data inputs.

Moreover, the complexities prevalent in the healthcare regulations especially of medical insurance and the processes employed in the way that medical services are billed and collected are often counterproductive in getting claims responded to with speed.

Points for an effective error free claims processing to improve profitability for your medical practice:

An efficient front desk staff who are well trained & knowledgeable with the intricacies of both, Medicare as well as different insurance payers and their coverage, is very vital in the initial stages of employing an error-free claims management process.

The next step would be to engage well credited coders and billers who are up- to-date with the complexities of the ICD-10 coding systems and appropriate modifiers to be employed.

Billers should be vigilant when examining and processing the claims as they are the most important elements of your claims management workflow.

Claims staffers who can rigorously conduct the follow-up of claims and provide well- documented

proofs in case of rejections and/or denials

Either  in-house  or  outsourcing  of  the  claims  processing  system  can  help  speed  your claims reimbursement to help profitability to your medical practice

It is hence very critical to carry out  medical billing and coding services with accuracy, as denial or rejection of the claims depends upon data inaccuracies and significant coding errors.

Posted in EMR / EHR / Health IT, Health Insurance, ICD-10, ICD-10 Coding, ICD-10 Testing, Revenue Cycle Management (RCM) | Tagged | Leave a comment

Woundcare Billing


While conflicting reports about wound care services and management still prevail, it is mandatory to understand that patient documentation is crucial for appropriate coding and billing for wound care services. There is a need to categorically deal with the issues of flaws and ambiguous coding for procedures for wound care.

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3 Ways I can reduce my medical billing costs



More and more physicians are feeling the burden of both administrative and operational costs. One would wonder how this affects their medical billing and coding practice impacting their Revenue Cycle management (RCM) system.

With the rules and regulations that the Affordable Care Act (ACA) has brought in together with the constant rule changes that the Centers for Medicare and Medicaid Services (CMS) that push medical practitioners to stay knowledgeable, healthcare providers seem to spend more time on getting acquainted with the rules and regulations that also affect the medical coding and billing process. According to the Practice Profitability Index, it has been stated that the percentage of physicians who spend more than one day per week on paperwork increased from 58 percent in 2013 to 70 percent in 2014 alone. Even though, digitization and online submissions are now being streamlined, the average five-year total cost of an in-office system according to the Michigan Center for Effective IT Adoption, puts it to $48,000 and for a cloud-based system pegs it at $58,000. Physicians are then spending more time on being updated and on learning how to deal with online systems, thus affecting their core focus- patient care! It has been estimated that nearly 70 percent of physicians did not want to transition to Electronic Health records, because of the spiraling costs, as per a 2013-12014 survey conducted by Medical Economics and Market Research firm MPI Group.

Further, adding to their frustration is the claims process where denials and appeals take forever, often leading to a lot of money being left on the table as healthcare providers do not have the time to chase after appeals. Most private insurers deny submission based even on small data entry or discrepancies like a miss-spelt name or a code error like a code digit being transposed.

Based on a survey as per the Medical Group Management Journal, the average cost of in-house billing is 12percent of a practices income.

There are three ways to combat this when you outsource

Staff Issues: Staff gets relieved and can focus on patient care. Absenteeism does not affect your processes. The outsourced trained staff handles the follow-ups, and trained in the process of verification and eligibility of the patient’s insurance coverage. Moreover, software and hardware installation costs are taken care by the outsourced vendor, leaving you, the physician, free to invest in medical equipment required and focus on your core practice

Knowledgeable Billers and coders: You can immediately save 35% directly on medical coding and billing costs. The stringent processes that outsourced medical billers and coders follow will help bring down the denials of claims which impacts your reimbursement cash flow cycle

Compliance: The Medicare rules and the insurance industry rules are constantly changing. Moreover, the healthcare industry is streamlining the process and requesting on a number of audits to be conducted internally as well as externally. For this compliance are a must and documentation of records and its storage, physically or even online, can be not just uncomfortable but also inconvenient and expensive.

An efficient medical coding and billing vendor, by taking care of the entire claims processing workflow, will in effect help improve your reimbursement and A/R collection, thus in the long run reducing your medical billing costs as staff, hardware & software and compliance is all met by them.

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Is Your Practice Perfectly Billing the ENT Procedures?


Perfectly billing the ENT ProcedureOtolaryngology on the outset seems to be a very casual practice, wherein the medical practitioner has to only deal with certain ENT procedures. However, it is much more than ear, nose and throat. The intricacies related to accurate medical billing and coding requirement is what outpatient facilities, as well as hospitals are trying to streamline, and frequent alterations in ICD 10 is also one vital reason, as to why one should not take these changes casually.

Getting to know your ENT Billing:

ENT workplaces offer a wide assortment of administrations to patients that have persevering or intense ear, nose, and throat issues. The variety of conditions that are exhibited at an ENT office every day requires doctors and staff to be constantly instructed on the treatment techniques and surgeries that are required to legitimately look after patients of any age. Worrying over collections, billing and the changing coding scenario can be tedious, and can make it troublesome for facility to create the client base expected to expand. Many medical billing companies offer outsourced ENT billing services in Florida, Ohio, Michigan and various other regions of the United States.

What ENT Billing Services are there on offer?  

One of the biggest worries that ENT and otolaryngology practices face is receiving appropriate income for all administrations rendered. If wrong code or modifier is utilized to charge for an administration, the claim might be denied or is underpaid. This can be devastating especially for small, independent practitioners and can cause large centers to lower their income cycle. Certified experts represent considerable authority in ENT billing and coding, and have upgraded with the knowledge base regarding any, medical billing, coding and modifier changes.

Many outsourcing firms specialize in various billing procedures related to ENT. Along with it, some of the most complex procedure for which they undertake coding and billing:

  • Endocrine Surgery
  • Surgical oncology
  • Congenital fissure and lip surgery
  • Treatment for sleep apnea and wheezing
  • Hypersensitivity treatment and medications
  • Sinusitis treatment and surgery
  • Treatment for vascular mutations

What are the exceptional ENT concerns?

As a rule, it is required that ENT treatment centers perform surgery and other therapeutic consideration around the same day. When this is the situation, it is basic that appropriate modifiers are utilized when billing or that the codes are bundled in the right approach to get payment from healthcare insurance providers. The team of professional billing and coding experts are very much adjusted with the CCI list for CMS, and will follow the best possible methods to ensure that suitable services are bundled, decreasing the number of claims denial, enhancing the reimbursement period and improving the overall income cycle of the facility.

Keeping a tab on Collection Services

Follow up is basic to getting payment for ENT administrations rendered. As a rule, understanding parities are higher for ENT procedures than for some other restorative administrations. The outsourced ENT billing staff will only address patients in the most gracious way, and will work in tandem with patients independently to guarantee the most noteworthy rate of revenue collection for ENT outpatient as well as hospital with the highest level of patient satisfaction.


The medicinal services industry is continually developing and changing, yet at this moment it is under scrutiny. The ongoing ICD-10 changes have been intense for a few practices, forcing many Otolaryngologists  to outsource their ENT billing undertaking to professional offshore agencies who exactly know, what to code for and how to bill.

Posted in Health Insurance, Healthcare Reforms, ICD-10, ICD-10 Coding, ICD-10 Testing, Insurance / Payer, Insurance / Payer Underpayment, Medical Billing, Medical Billing & Coding jobs, Medical Coding, Revenue Cycle Management (RCM), Uncategorized | Tagged , , | Leave a comment

Let your prime focus be on Patient Care!


Somewhere along the way you decided to become a medical practitioner and use that knowledge to help and treat people. You didn’t spend all those years studying medicine to end up spending most of your time billing and coding for the procedures you performed. Yet, by now you must have understood, this is what is exactly happening.

There is no doubt that a patient’s care holds a top priority in your practice, but you cannot deliver superior services without understanding the patients bottom-line.  Many factors, including improper coding and distracted patient care can overwhelm patient relationships, which can in-turn affect your practices reputation and brand loyalty.  Most of the medical practitioners are honest and work hard to improve their patients’ healthcare needs. But for some, overbilling the patients not only brings them under critical observation or examination, but also spends valuable resources like time, money and efforts to amend the situations. To make matters worse, if the practitioner is not able to fix such a situation, could result in damage to the practices reputation, thereby affecting the future costing’s and revenue.

Today, Medical practitioners and caregivers cannot entirely depend on patient care; they also need to ensure that they have a professional and qualified staff to take care of the errands that take place after the patient leaves the clinic. This is actually where the medical billing and coding cycle begins. These professional make sure that the medical practice and the insurance companies work hand-in-hand to ensure that proper claims, reports, and payments are made for the physician. This has not only relieved the practitioners from the billing woes, but also enabled them to focus on patient care over the past few years.

Improve efficiency with greater focus on patient care

An average physician spends days and years to become a proficient medical practitioner. With a shortage of skilled physicians on the horizon, it is not possible that today’s independent practitioners will be able to find enough time treating patients  to manage the complex and tedious task of billing  and Accounts receivable(AR) management.

Since the very beginning, with the modern healthcare undergoing a pattern shift, it has become challenging for the medical practitioners to remain profitable and offer top class patient care. Individual practices and large hospitals, all have to deal with the medical billing procedures, and this has led many offices ease out the time-consuming job of bookkeeping and coding. This is one of the many reasons why many practices prefer outsourcing their medical billing and coding to run a smooth practice.

If your goal is to spend more time on your practice and give more care to your patients, you ought to find a management solution that frees you from worries of your billing services. Outsourcing Medical billing can only free you from things you shouldn’t be doing other than patient care. The cost of outsourcing is certainly lesser than doing it in-house.

In addition to cost saving, your medical billing company can:

  1. Provide professional consultation to evaluate your procedures and policies.
  2. Dedicated experts to ensure proper claim filing, collections and payments.
  3. Help manage your medical records.

These professional services provide you the freedom of what you are best at, so that you can provide the best medical care to your patients. More and more physicians are favoring to outsource the demanding and challenging tasks associated with billing and collection of payments for their services.

Let the Focus be patient care – not patient bills

Redirect your practices resources from patient billing towards activities that can make you achieve greater economies of scale. Outsourcing your billing responsibilities can allow you to focus more on other critical areas of medical care.  Seeking the help of an experienced billing partner will give your busy practice more time to devote in research. Outsourcing is not about disowning responsibility or giving up control. It is about improving the order and quality of the business practice.

Outsourcing allows you to sustain your focus, to keep patients coming through the door and to create and sustain a successful, satisfying practice.

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