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How Medical Billing Consortiums Are Superior to Medical Billing Companies

December 05, 2012



The origin of medical billing practices in the U.S. can be traced back to the 1960s when Medicare was introduced as a parallel to cash-based medical services. Since then, insurance-backed medical service has grown enormously, and two-third of the total physicians’ fees is routed through insurance of some form or the other. This shift in compensating physicians has made medical billing more complex than ever before. While medical practices initially tried to manage with in-house medical billing practices, they gradually had to give up because of internal incompetence and escalating cost of training and system deployment. As a result, outsourced medical billing practices have become the order of the day.

Outsourced medical billing practices come in various forms – freelance consultants offering billing services, dedicated medical billing companies providing comprehensive billing services, and billing consortiums with differentiated billing practices. While practices can choose the one that best suits their budget and expectation, there is an over-whelming inclination towards Medical Billing Consortium.

Medical Billing Consortiums versus Medical Billing Companies
Cost is a major factor that has made medical billing consortium more popular than medical billing company. Medical billing companies operate from a pre-determined location, which may be far away from care providers’ facilities. As movement of resources involves considerable expenditure, physicians feel burdened with inclusion of such expenditure in fees payable to medical billing companies. Whereas billing consortiums, with affiliates across major clinical destinations, provide economies of mobile resources.
U.S. health care reimbursement environment is characterized by multi-payer system – Medicare, Medicaid, and a host of prominent private payers. Moreover, these health insurance schemes are governed and get modified according to state-specific laws. A medical billing company may not be conversant with region-specific variations prevailing in all of the 50 states. But a billing consortium, with affiliates drawn across the states, can be relied upon to deal with such variations.
Comprehensiveness is another trait lacking in most of the medical billing companies. While there are certain companies that are highly specialized in billing select-few disciplines, billing companies with competence for the entire range of medical disciplines is a rarity these days. Large hospitals that require billing services for the entire range of medical disciplines may not like the idea of dealing with too many service providers. Medical billing consortiums, which normally comprise professionals of diverse billing specializations, are preferred for their inclusive medical billing practices.
Care providers’ are put through a host of healthcare reforms – Medicare cuts, mandatory EHR compliance, possible shift to ACO model, and ICD-10. While opting for outsourced mediation from medical billing companies may seem an instant justification, billing companies too are restricted by geographical confinement, resource constraints, and limited competence. Consortiums, on the other hand, are agile, resource-rich, and infinitely competent with their vast and varied professional base.
Medical billing companies may be susceptible to resource-crunch during times of attrition or turnover of professionals, which is likely to affect practices’ clinical and operational rhythm. Conversely, medical consortiums rarely face such adverse times due to their vast affiliation. With readily available reserve-pool of resources, consortium can ensure that practices’ do not experience cluttered service flow.


Medicalbillersandcoders.com is a leading billing consortium with a professional base across the 50 states in the U.S. Over the years, practices of varied size and specialization have tried, tested, and endorsed our billing services as comprehensive, practical, and transformational. With a credible history and agile, resource-rich and infinitely competent affiliations across the 50 states, we are confident of transforming the recent health care directives into opportunities for care providers.

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Category : Outsource Medical Billing