Revenue Cycle Management (RCM)

3 Signs that Show Need of Outsourcing Revenue Cycle Functions

Healthcare providers are under increasing pressure as more and more patients are shifting to value-based care. Providers are already under pressure as they have to deal with declining reimbursements, higher risks, and tighter margins while improving patient care. Due to this, hospitals and physician practices of all sizes are being forced to re-examine their revenue cycle strategies and are in need of designing new rules of engagement with patients, staff, and payers. Some of the providers and healthcare institutes handle this pressure by outsourcing their revenue cycle activities to the medical billing companies. In this blog, we pointed out three prime signs that show the need for outsourcing revenue cycle functions for your practice or healthcare institutes. 

As per a recent Black Book survey report, 83% of hospitals outsource a portion of their accounts receivable (AR) and collections, 58% of their contract management, and 55% of denial management, while 68% of physician groups with 10-plus providers outsource collections and/or claims management. Another survey of hospital CFOs shows 38% outsource all or part of their revenue cycle functions, and another 24% are considering it. These decision-makers in healthcare institutes see that partnering with a medical billing company can deliver benefits, such as higher reimbursement, better cash flow, improved margins, and increased patient satisfaction.

3 Signs that Show Need of Outsourcing Revenue Cycle Functions

There are many signs that suggest the need for outsourcing revenue cycle functions, some are clear-cut; others may be less obvious. This article highlights three signs healthcare executives should notice to protect and improve their organizations’ financial outcomes and patient satisfaction rankings.

Inefficiencies in Revenue Cycle Functions

Inefficiencies in revenue cycle functions include missing charges, inability to distinguish between billable and non-billable procedures, wrong patient demographics and insurance information, wrong use of procedure codes and modifiers, unable to interpret EOBs and ERAs, unable to categorize denied claims as per denial reasons, and many others. All these inefficiencies are introduced due to lack of skilled billing, coding, accounts receivable, and denial experts; insufficient training, and lack of internal and external audits. As physicians are busy and not able to dedicate much time for revenue cycle functions, a lack of communication between physicians and medical billing staff could be the prime reason for such inefficiencies in revenue cycle functions. 

In-House Staffing Challenges

The revenue cycle functions require medical specialty expertise staff who are well trained and possess data analytics capabilities. Find such experts remains a problem for hospitals and physician practices. A recent report shows that nearly 31% of hospitals and physician practices accepted that they can’t find enough candidates to fill open positions. Outsourcing removes recruiting, training, onboarding, and other people-related costs from your balance sheet. If you outsource, medical billing company can hire and train representatives to improve your patients’ experience, optimize your revenue opportunities, and free your organization to focus on what it does best: delivering quality patient care.

Patient Collections are Lagging

As discussed earlier, shifting more patients towards value-based care leads to more patient responsibility i.e., high deductible health plans and high co-payments. Collecting these payments from patients can be costlier and more time-consuming, than obtaining payer reimbursements. A recent study reveals that the percentage of collections from patient accounts with balances greater than $5,000 are four times lower than collections from low deductible health plans. Overall, the study found average self-pay after insurance payment made up 10.9% of all inpatient AR and 18.2% of all outpatient AR. In such cases, you need assistance in eligibility and benefits verification where the medical billing company will share patient eligibility and insurance benefits reports in the prior appointment and if required, complete prior authorizations. 

If you have witnessed these three signs then be sure that your healthcare institute is in need of outsourcing. MedicalBillersandCoders (MBC) can streamline your revenue cycle functions and bring more efficiency. Our team of expert medical billers and coders can help to streamline your billing and coding processes like eligibility and benefits verification, prior authorizations, charge entry, claim submissions, payment posting, denial handling, accounts receivable management, medical coding, and provider credentialing. To learn more about our commitment to excellence and performance for medical practices and healthcare providers, contact us at 888-357-3226


Medical Billers and Coders

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

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