A Future for Outsourced Medical Billing

A Future for Outsourced Medical Billing

Many medical practices are now seriously considering managing their financial activities through medical billing experts. Outsourcing has become a need for every health service provider, because of consistently higher denial rates and low reimbursement from the insurance provider.nnOn the other hand, it is not easy for every health service provider to hire staff exclusively for billing activities. The hiring process and lack of resources also put in-depth stress on them to have assistance from a medical billing expert and most probably we will see this trend growing in coming years. nnWhile there are lots of speculations about the future of Outsourced Medical billing. We will show you why its future is bright but first, we look at the difference between outsourced medical billing and in-house medical billing. n

Difference Between In-house & Outsource Medical Billing 

nIf you will start figuring out the differences between in-house and outsource medical billing then you will see that there are some pros and cons associated with in-house medical billing and there are some pros and cons associated with outsourcing medical billing. Here is the difference between both these processes.n

In-house Medical Billing

nThe in-house medical billing activity is conducted by the health service provider within the healthcare system. The staff members are responsible for all the revenue cycle management.nnIn this system, the health care staff is supposed to enter all the required details in the medical billing software when a patient comes for the services.nnThis documentation has essential details about the patient’s medical history and his insurance coverage which will later define whether he is eligible for the services or not.nnBefore submitting the claim to the insurance company the claim is forwarded to the clearinghouse whose job is to review the claim before submission. nnAfter submitting the claim to the insurance company they will let you know about the acceptance and denial of that particular claim.n

Outsource Medical  Billing

nWhen health care service providers choose to have assistance from a third party known as medical billing services to manage their revenue cycle management.nnIn this activity, your practice loses control over their financial management and all the related tasks will now be managed by an outsource billing team. nnAn outsourced medical billing service will manage all the activities like submitting a claim, data entry and even they will follow up on the denied claim. nnThey will also send invoices to the patient and strictly monitor your outstanding account receivable. nnMost of the billing services charge a percentage off collection or they may charge on a monthly basis for their services.n

Challenges in Medical Billing 

nRight now the health service providers are facing multiple problems in the revenue cycle management system. These challenges are crucial for every health care system in order to maximize their revenue to operate at their full potential. Here are the challenges in medical billing.n

Higher Ratio of Denied Claims

nIn recent times it has been seen that the ratio of claim denials increased significantly. Many health practices lose a significant amount of revenues due to denied claims. nnWe can say that the inexperience in handling the billing activity and lack of effective resources to handle the RCM is one of the top reasons behind this. While many of the denied claims are avoidable and can be resubmitted after the correction.n

Incomplete Data

nThere are many health practices that are still using the manual way of documentation of essential details. Which eventually will increase the chances of errors in any documentation that might be the reason for low reimbursement and higher denial rates.n

Insurance Eligibility

nPatient eligibility for certain treatment is one of the reasons behind the denial rates. It is the responsibility of health service providers to take a proper assessment of the insurance scope before rendering the treatment.n

The Rise of Telehealth

nRecent events like the covid-19 pandemic have completely changed the behavior of the general population. During the pandemic, people prefer to have a general check-up through online video conferencing so they can avoid going to the health centers due to the high risk of the virus.nnNew technology comes with new challenges same case applied to telehealth services in which the risk of getting lower revenues is still high and many of the health service providers are consistently focusing on it.n

Why Outsourcing Is The  Future?

nAll the health care service providers need an efficient setup to manage their RCM. On the other hand, they also have a responsibility to give their patients better health facilities.nnManaging both activities at the same time is not easy for every practice. Changing regulations and mass adaptation to telehealth services also raise challenges for the healthcare service provider. In that scenario outsourcing is the best option right now and here are some of the reasons behind it.n


nThe cost related to billing activity is much lower when you opt for outsourcing. It is cost-efficient in a way that when you opt for an in-house building then you have to spend a lot of your money in the hiring process and sometimes on the training process. Your practice also requires the latest software solution for the proper assessment of your document which is very costly.n

Reducing Billing Error

nOutsourcing assured you the minimum error in your billing as they have an experienced team. They are well aware of the insurance companies and common occurring coding errors in the claim. So, they can better manage all these activities compared to the in-house building team.n

Following up

nMany billing service providers have an active team for following up the denied or unpaid claims. which will eventually enhance the chance of getting maximum reimbursement for the services.n

Higher Transparency

nA high transparency rate is one of the prominent features which makes it more valuable for the medical service provider. Teams are bound to provide the services and a comprehensive performance report which will allow them to evaluate the present scenario of their financial system and they can also forecast this activity.n

Need Help?

nNow you have seen that outsourcing can give you an edge in better management of your RCM. If you are looking for medical billing solution for your practice then Med-Miles can help you in managing your financial affairs as we are well aware of the regulations by the financial system and we are also well aware of the common errors in the claim. You can call us at 8885 989 181 for more details.

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