The Affordable Care Act and other regulatory requirements have impacted many specialty services, given the stringent auditing that has been implemented to check into the accounts management processes. Many specialties, including Otolaryngology that encompasses the ENT services are now turning to outsourcing certain services to not only keep costs down but also ensure accuracy in coding and billing practices, which have impacted their Revenue Cycle Management process affecting profitability.
Improper billing can lead to claims being rejected and/or denied. Denials require appeals with stringent documentation. Mishandling of claims affects revenue loss, either via insurance reimbursements, or via Medicare reimbursements.
The new regulatory requirements also require that processes and workflows are in proper order. Filing claims and reports online and the stress on maintenance of Electronic Healthcare records (EHR) brings in its wake the need for automation of the accounts management systems. This requires heavy investments in software and hardware that can lead to more loss in the revenue cycle along with untrained and ill prepared staff. All this will lead to further investment into the regular training of staff due to periodical changes in the regulations. So the natural and simple solution what ENT services now do is outsourcing their medical billing services so that they can focus on the core practice- patient satisfaction!
By outsourcing, especially the claims process or the account management process, ENT services can do away with:
ENT services that are still hesitant to jump into outsourcing their medical billing services due to reasons like loss of control or quality and inconsistency in coding and billing, or fraud via filing claims, can conduct their own research into the third party vendor by asking pertinent questions with due diligence. Once you are aware of what is required from the government agencies and insurance agencies, then integrating a third-party vendors system into your processes and workflows should be worked out as per the plan approved after validating their credentials.
ENT services have realized that by outsourcing their medical billing services, they are now able to optimize their clinical workflow for higher financial and clinical performance. With third party vendor's constant follow up with payers to check on claims and tracking changes in payer reimbursement, the result is an improvement in the practices' net collection ratio, reduction in days in accounts receivable (A/R)and increase in the per-encounter reimbursement. Now who wouldn't like to see their cash flow increase?