Outsourcing medical billing and coding services are required when the healthcare facility or the solo practitioner is becoming a challenge, collections/revenues are steadily going down, billing processes are inefficient, there is high staff turnover, training, and technology costs are high and non-compliance issues are cropping up regularly.
There are also times when fixed expenses need to be turned into variable ones along with reducing the workload on the office administrative staff. Outsourcing companies have trained staff/specialists (are more aware of the latest and constantly changing rules and regulations) and allow the practitioner to focus on care while these companies focus on increasing revenues.
However, sometimes there are mistakes made by healthcare while choosing to outsource medical billing. They are:
1. Performance metrics and value-added services:
Sometimes, healthcare organizations miss out on seeing the billing details and are too sizzled by the outsourcing organization’s add-ons. Find out the reputation/credentials/experience of the outsourcing billing company. Ensure that the outsourcing company shows you all its billings, timely payment details, medical services relevant to your business, success, and volume of all its billing processes.
It is important that your outsourcing company knows the fundamentals of your medical specialty (rules, coding, denials, appeals, etc.). Ensure that compliances such as HIPAA are followed and their staff is well-trained, possesses the technology to prevent frauds, and protects information. Check if they also offer added services such as verifying insurance of patients along with offering them online payments online, maintaining claims reports, etc.
2. Strong and well-designed contract:
Too often, the healthcare organization gets carried away by the sales process and dives in for the contract. Ensure that they are registered/have a license to work for in the state along with professional liability insurance. Carefully review all clauses (preferably by a lawyer), especially those conditions which are mentioned in the fine print.
There should be a check of all responsibilities clearly mentioned in the contract. Also, get down to the mandatory ‘escape clause’ in case the services need to be terminated sooner than the contract ends or the ‘service level agreement clause’ for any cost negotiations. Also clarify the rules which clearly mention the person to be contacted in case of service, quality matters, disputes, and/or irregularities.
Don’t depend on just one reference. Always make phone calls to many references/customers (rather than just reading testimonials). Check the practice size the outsourcing company has been working with/is capable of handling. Know if they treat the patients well with billing queries. For your practice, claim errors can be very taxing to handle with a sure shot slowdown on revenues if the outsourcing company is not capable enough to handle fine distinctions.
Medical billing, coding, and reimbursement require knowledge, skills, efforts, and patience. One must understand that managing services in-house and managing them outside is a completely different state of affairs. Assess overall stability, the business strategy, and the achievement of the outsourcing company. You should be able to trust the outsourcing company with your billing aspects.