Four Indices That Your Practice May Need to Outsource Medical Billing

Do dealing with CPT and DX codes cause you to pull out your hair on a daily basis? Are you worn out with the endless stream of time-consuming denials and rejections that you have had to follow up on?

These questions may have been answered "yes" by a high-volume dermatology practise located in Eastern Connecticut that has been a client since 2005. The realisation that a billing service could assist them in keeping up with demand and billing, in addition to tracking appointments and cancellations, was the moment that they had their "a-ha" moment.

The practise manager stated that in the event that they did not use a medical billing partner, they would be required to recruit two extra full-time staff solely for the purpose of handling insurance billing.

If you want to keep your practise going smoothly without having to pay someone to work night and day on invoicing, it may be time to look for a business partner outside the four walls of your current establishment.

Do you still have doubts? Here are four warning flags that indicate it could be time for your firm to outsource its billing and collection processes.

1) You've decided to place all of your faith in a single person.

Be wary if your clinic has put all of its financial management in the hands of a single employee, as this puts your firm at increased risk for theft via embezzlement. A research that was conducted by the MGMA in 2009 found that 83 percent of practises that were polled had been the victims of theft or embezzlement committed by employees.

2) The filing of all claims is the responsibility of a single individual.

Even the most motivated office manager is struggling to keep up with the increasing complexity of the requirements for successfully submitting a claim. If your clinic relies on a single individual to negotiate all of the electronic field requirements and to keep track of which carrier demands certain fields, your practise may be wasting both time and money.

3) You do not have anybody on staff who is responsible for monitoring and following up on each claim that has been submitted to each carrier.

The dangerous pattern of "submit and forget" is developed by a significant portion of practise personnel. In the event that the claim is misplaced by the carrier or the carrier requires additional information before they pay, the claim runs the risk of being neglected and eventually becoming obsolete as an unpaid claim. Who on your team is going to be able to track each claim that's been filed with each carrier and give that claim their full attention and time? Do the systems you now use have the essential capability to accomplish this?

4) A reliable member of your family or a student is in charge of managing your billing.

The business of managing revenue has grown just as difficult as the process of filing taxes, if not more so. What percentage of practises make an attempt to manage their own taxes? So why put yourself through the hassle of managing claims and following up with carriers? Take into consideration the fact that one must pay taxes every three months. Billing takes place on a daily basis, or at the very least it should take place on a daily basis, and the volume is far higher. The odds are increasingly stacked against a practise that anticipates being able to manage this process by employing a trusted family member or student who has recently graduated from a billing school that lasts for six months.

The practise of billing is much more professional. It is now more comparable to employing a certified public accountant or selecting seasoned legal counsel in terms of the level of expertise and financial investment required. After all, this is a business choice, and how you choose to proceed will have a direct impact on the profitability and security of your practise.

If you are still having trouble managing this function internally, you should think about the amount of time and money you are wasting, not to mention the amount of hair you may be losing. Perhaps now is a good moment to consider the potential influence that a billing partner could have on the day-to-day operations of your business as well as the amount of income collected.