Have you reached such a state of hyper anxiety and at a loss as to why you ever outsourced the billing? Is your Revenue Cycle process not making any profits? Have your administrative and operational costs not reduced? If you answer yes to all of these- then yes your billing vendor has ruined you.
But wait…there is no jumping from the frying pan into the fire lesson here if you want to look for another billing vendor. Instead, here we would deem it essential to take a step back and analyze what went wrong and where.
In early 2013 when healthcare reforms led to lowered inpatient volumes and the federal sequester lowered the Medicare reimbursements by 2 percent, there were only two options for most healthcare providers- layoffs or outsourcing. In 2015 with the new reforms placing emphasis on collaboration and Value-Based Performance Fee (VBPF), rather than a fee for services (FFS), the need to focus on the core business, reinforced the need to drive costs down and outsource. However, many healthcare providers took risks and blindly outsourced without weighing the pros and cons when they outsourced the services and what exactly were their own requirements
Depending on the size of your practice, outsourcing any one component of the Revenue Cycle process may be deemed appropriate. Against the backdrop of today’s healthcare rules & regulations, and reforms, medical billing has become a complex and time-consuming affair. Further, with the Value-based Performance Fee (VBPF), healthcare providers now need to concentrate on their core practice- patient’s health. The administrative burden, but naturally should be reduced and outsourced.
Ask yourself these 4 queries and we can then take you to the next level:
- Do you see yourself handling practice management software to keep track of your patients’ balances and sending bills to payers?
- Do you have the financial resource to hire certified medical coders on staff to oversee the operation?
- Do you have a ready staff that is knowledgeable, focused, and reliable to handle the billing?
- Do you have the bandwidth or exhausting your staff’s bandwidth into responding or chasing any rejections or denied claims?
If yes, then you can forget about the third-party vendor and go solo, but remember that down the line your business will grow and the same staff will not be ready to handle the influx and keep updated.
But, if the answers are No, then this simple checklist will help find the right vendor
- Has the billing service that is being recommended increased the collection rates with other companies?
- Have they reduced rejections and denials?
- Do they have the means to provide an analysis of your accounts receivable?
- Do they generate on-demand reports so that you can view your day-to-day finances through the company’s software as well?
- Is the staff adequately experienced or being trained to handle the latest healthcare rules and regulations?
- Is the A/R well received within the prescribed number of days- 60-90? Or do they have a few that extend beyond 120 days? If the latter, think twice as this is what helps cash flow
- Have they any specialty coders and billers that can help especially with your specialty healthcare?
So do remember, even if burnt once, you now know the pitfalls, and can analyze the situation and ask the right questions! If when outsourcing the revenue cycle management process can help result in more money for your practice without allocating your own staff to complete the arduous tasks of medical coding & billing then this art is best left to the experts in their own field.
A Subject Matter Expert in healthcare billing operations with nearly 10 years of experience, sharing insights on claims processing, coding support, and revenue cycle optimization. Dedicated to educating healthcare professionals on compliance, accuracy, and strategies to improve billing performance.
