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Outsourced Medical Billing – the prescription for new practices’ impressive ROI

August 10, 2011

Given the rapidly expanding patient base, and an insatiable demand for quality medical care, it is not surprising that each passing-by moment is witness to the birth of a new practice. Despite being driven by a larger healthcare vision, new practices – operating in a market-driven environment – are inevitably forced to lend equal significance to Rate of Return on Investment (ROI), which is the operational yard-stick for sustenance and growth in a highly competitive medical service market.

If pooling in the requisite resources to launch your medical services is one huge task, operating it on profitable basis is altogether a different proposition. Having ventured into a socially-responsible service, most of your time and resources will be expended on employing the best of physicians, diagnostic and curative measures, support and administrative staff, and facilities – all of which have direct impact on quality medical care, patient satisfaction, patient retention, and credibility that would further expand your patient referrals.

Assuming that you go on, and eventually achieve the objective you set out for – medical service credibility – would there be any guarantee that you would have achieved an equally credible and sustainable Rate of Return on Investment (ROI)? Medical bill realization, which is a matter of insurance coverage, would weigh heavily on venture practices, who are generally novice to stringent billing regimen governed by CMS. Further, a full-fledged in-house medical billing team may not be advisable as it, being slow to yield results, is equally capital-intensive requiring heavy investment on: Installation of Billing and Coding Platforms, and Training the staff on best practices in medical billing.

Amidst the prevalence of such uncertainty on in-house medical billing results, it is prudent to source your medical billing needs from a competent outside agency;

  • Application of Advanced Technology Interface comprising use of latest medical billing softwares such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc.,
  • Use of latest coding softwares such as EncoderPro, FLashcode and CodeLink
  • Application of standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting
  • Successful track-record of processing medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well

Beyond the above requirements, the Medical Billing agency must also provide comprehensive medical billing complete with:

  • Patient Enrollment
  • Insurance Enrollment
  • Scheduling
  • Insurance Verification
  • Insurance Authorizations
  • Charge Entry
  • Coding
  • Billing and Reconciling Of Accounts
  • Denial Management & Appeals, and
  • Physician Credentialing

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billers in U.S. for over a decade, and whose medical billing service – complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, account receivables, and compliance standards – can be an ideal solution for new practices that require phased implementation of medical billing process before considering in-house medical billing themselves.

Going by the recent statistics – 30 to 40% reduction in medical billing costs – our comprehensive billing solution is the prescription for new practices that seek an impressive ROI through simplification of revenue cycle, appreciable increase in collection rates, more patient inflow and referrals, and increased avenue for medical research and development.

Sources of Reference:

  • Web articles on Optimizing Medical Operations
  • CMS guide on best avenues for venture professionals

Category : Outsource Medical Billing