Outsourcing Medical Billing: A Comprehensive Guide for Your Practice

January 21, 2021 by Antonio Arias, MBA, CHBME

Topics: Practice Management, Medical Billing Company

When it comes to thriving practices, in-house employees are very often the top contributors to the organization’s success. But, regardless of talent, skill, or capability, these individuals often lack the time and availability to keep up with the ever-changing tides of the healthcare industry, especially when it comes to the particulars of medical billing.

For medical practices to achieve success, a responsible plan for financial health must be prioritized. By outsourcing medical billing, your practice can have the most efficient and accurate bill processing possible.

There are numerous benefits of outsourcing medical billing, but the initial thought of moving such an integral process of a medical practice’s revenue off-site can be daunting. Follow this comprehensive guide for everything a practice needs to know about why outsourcing medical billing may be one of their best financial moves - and understand why it’s increasing in popularity.  

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What are Outsourced Medical Billing Services?

medical billing services

Many medical practices process billing with in-house staff. With an in-house billing team comes the responsibility for the potential complications that come with the billing process. Whether it be organizational issues, delayed payments, or any other challenges frequently associated with the medical billing process, your in-house billing team can quickly be overwhelmed.

By outsourcing medical billing, your medical practice can avoid these common stressors. Outsourcing your medical billing is when your practice lets a dedicated third party code and bill your procedures. By trusting a medical billing company with your information, you can rely on the professional expertise of their staff to find the most comprehensive and efficient way of processing your coding and billing so your medical practice can focus on other areas of improvement. 

Key Differences Between In-House vs. Outsourced Medical Billing

There are several significant differences between in-house and outsourced medical billing, the most obvious being the billing location. While an in-house billing team is stationed within the medical practice, outsourcing medical billing is an off-site third-party. However, there are other marked differences as well. 

Control Over the Medical Billing Process

A medical practice with an in-house medical billing team has total control - and ownership - of the medical billing process. Outsourcing your medical billing takes the responsibility of your medical billing from your practice, so it can focus on delivering care to patients. Since there is plenty of trust involved, choosing the right medical billing outsourcing company is essential. 

Reduced Risk of Medical Billing Errors

Medical practices with in-house teams are more at risk of making costly medical billing and coding errors that can affect reimbursement from insurance companies. Outsourcing medical billing services are composed of experts who have the time to carefully process your billing accurately. 

Vast Medical Billing Expertise

Although your in-house billing staff may have plenty of qualifying experience, outsourcing medical billing removes many of the stressors your medical practice faces when it comes to the process. Besides being dedicated solely to your billing, the staff at medical billing outsourcing companies are aware of any changes to the regulatory environment and how that may impact your practice.  Ensuring compliance means your medical practice will have the most accurate processing possible.  

Why Outsource Medical Billing in Your Practice?

medical practice outsourcing medical billing

When considering outsourcing medical billing, you have to make sure that it is the right decision for your practice. While outsourcing medical billing isn’t right for every single practice, it provides a far more controlled and sustainable approach to revenue cycle management. For thriving or expanding practices, the true value of outsourcing is its long-term viability. As a practice’s patient load, staffing levels, and other dynamics evolve over time, an outsourced medical billing firm can typically maintain better consistency (and control) of a medical practice’s finances than an overburdened internal team. In fact, the benefits of outsourcing medical billing are numerous and extend to all areas of your practice. 

Some reasons why your medical practice should consider hiring medical billing outsourcing services include:

If You Don’t Have the Time or Availability

In the medical field, we often wear many hats and have a wide range of responsibilities. However, medical billing is a full-time job. In order to stay on top of the volume of transactions in an accurate and timely manner, you’ll need personnel who are dedicated entirely to billing. By outsourcing medical billing for your practice, you will save your staff hours that can be allocated to other pertinent needs. 

Faster Insurance Payments

When billing errors are minimized, reimbursements and payments can be received in a shorter amount of time. By employing expert medical billing outsourcing companies, you can enjoy streamlined workflows, increased revenue, and better earning potential for your practice—which clears a path for payments to come through much more quickly and efficiently.

Enhanced Transparency

Physicians often think that outsourcing medical billing is akin to relinquishing control of the RCM process to a set of strangers – but that couldn’t be further from the truth. Once you contract with a firm, your outsourced billing team becomes obliged to earn you positive marks on a defined set of metrics (think first-pass payments, denial rates, collection ratios) and to provide data on efforts and outcomes, giving you unprecedented transparency into your revenue cycle.

Reputable medical billing outsourcing companies will regularly supply you with comprehensive performance reports, and most will keep you better informed of delays and payment issues than your on-site staff does. That means you maintain control of RCM without having to micromanage – or even oversee – any billing staff.

Reduced Costs

When it comes to maintaining an in-house medical biller, there can be a lot of hidden expenses that make it an unwise investment. From overhead expenses like training costs, benefits, insurance, and payroll to hardware/software installation costs, there are plenty of fixed expenses that can be significantly reduced, if not eliminated, with outsourcing medical billing. 

The fact of the matter is that many practices don’t have the disposable income or time availability to maintain an entire billing department and find a replacement anytime an employee leaves. By outsourcing this area of work, you can depend on your medical billing firm to be a more controlled and sustainable approach to revenue cycle management.

Fewer Medical Billing Errors

Speaking of costs, billing errors and other inefficient collection policies have the potential to result in a huge revenue hit. Everyone makes mistakes—but when it comes to medical billing, just one mistake can turn into a delayed payment for your medical practice. Between incorrect patient information, authorization errors, duplicate billing, and more, billing errors can be a costly expense. 

Outsourcing medical billing helps ensure it’s profitable for your practice and that the medical billing process is up-to-date and free of human error. The right billing experts who specialize in your field have quality assurance measures in place that make them less likely to make errors. Partnering with expert medical billing outsourcing services can result in a streamlined workflow, reduced mistakes, and increased revenue and earning potential for your medical practice.

Ensured Compliance 

As we’ve established, healthcare has ever-changing regulations that can make medical billing extremely difficult to keep up with. There are always new protocols to be aware including changes in Medicare, Medicaid, and third-party payers.

Although it’s hard to predict what those changes will entail, it’s easy to predict that the standards will evolve. Properly following each changing protocol requires a dedicated expert to stay up-to-date on new information as frequently as it arrives.

Medical billing outsourcing services have to stay on top of changes like these on a regular basis. This helps ensure they’re always submitting clean claims and that the practices they partner with are always in compliance.

Expert Consulting

The process of insurance billing is complex and has many moving parts. There are constant changes to the types of questions and scenarios that may arise in the various areas of revenue cycle management (Who do I call about resolving a denial? Which is the most updated code modifier I should use? Is United Healthcare quicker with paying claims than Humana?). 

Industry regulations evolve rapidly and if you don’t have someone on your staff who can stay on top of the latest standards and expectations, your medical practice will fall behind. Outsourcing medical billing ensures that you always have a team of people dedicated to best practices in your specialization.

Easy to Integrate With Your EHR

Anyone currently handling medical billing in-house knows that managing various electronic health records (EHR) systems can make the whole process a time-consuming, frustrating nightmare. Some medical practices fear that outsourced billing services may not be easily integrated with their current practice management or EHR systems. However, solutions offered by billing vendors like NCG Medical include extensive experience with major systems like Allscripts, Aria, GreenwayHealth, eClinicalWorks, Mosaic, Nextech, and more. By outsourcing medical billing, you won’t have to lose any more sleep worrying about many of the technical issues that come with managing the billing side of EHR systems.

Growth that Scales 

When medical practices aren’t bogged down with medical billing complications and can focus on everyday responsibilities, there’s so much potential for scalable growth. Regardless of the size of your practice, outsourcing medical billing can help eliminate interruptions, distractions, and complications that would otherwise prevent your practice from reaching its full potential. It can scale as you do, so growth is both achievable and manageable.

More Satisfied Patients

Every medical office aims to deliver excellent care and customer service, but juggling everything on your practice’s plate can make it difficult to meet all your patients’ expectations. Your support staff is always going to be responsible for managing scheduling tasks, executing patient check-in and check-out, keeping the books, and handling clinical concerns.

By outsourcing medical billing, you’re taking something off your team’s hands – something that can usually be better managed by another entity. In doing so, you’re freeing up your staff’s time to better attend to patients’ needs, resulting in higher satisfaction rates and better patient retention.

What to Look for in Medical Billing Outsourcing Companies 

While the benefits of outsourcing medical billing are numerous, the key to success is to outsource wisely. Make sure to ask these questions when looking for the right provider for your practice. 

How Quickly Will They be Able to Begin Processing Insurance Claims?

In a typical situation, 30-60 days provides enough time for a company to begin services. However, this is not an exact science and many factors play into this timeline. For example, if you do not need to change your practice management software and they are versed in the practice's software, it could be a very quick transition. In this instance, the main focus would be on creating user credentials and providing software access to the medical billing company. 

If this is not the case, and the practice management software is not on the same system, the timing will be affected by whether data is going to be exported, imported, or manually entered. Also, sufficient time will be required to set up electronic connections to the various payers, leading to a potentially longer implementation timeline. The company you are considering should be able to provide references for practices with an implementation plan similar to yours. Reach out to those references; if they had a positive experience, it will be proof that your partner has experience in this type of implementation. 

What Medical Billing Services Do They Provide?

Revenue cycle management is a complex process, which involves a variety of important tasks. It is vital to clearly identify each of these tasks, and assign them to either the practice or the medical billing company. Not every medical billing contract is the same. For example, your practice might want to input charges on-site, while another practice might choose for the billing company to not only enter the charges, but also complete the coding for the encounters. All steps need to be discussed and clear expectations set.

What Training Does Their Staff Receive?

Proper training of a medical billing company's staff is essential to maintaining their core competency. Before you engage in any agreements, confirm that the billing staff is certified and receives continuing education to maintain their certifications.

Who Will Handle the Current Accounts Receivable (A/R)?

It is important to determine who will be handling the current A/R before services begin. To minimize the chances of old, non-paid claims falling through the cracks, the best practice would be to start fresh, especially if you are changing practice management software. Some medical billing companies will take on the current A/R and run the old claims out. This is also something the practice can decide to keep in-house and manage themselves. Either way, for about 90 days, depending on the total amount of A/R, there will be two different medical billing processes running concurrently.

Will Monthly Financial Reports be Provided?

Professional medical billing companies will not only provide you access to your monthly financial reports, but will also automate and interpret these results for you. The reports will provide the practice with monthly financial summaries, highlight trends, and offer advice based on the practice's results. Access to financial dashboards for 24/7 monitoring should be available, and will allow quick confirmation that key performance indicators are being met. A good medical billing company will establish KPIs and set standards for monitoring.

A reputable billing company should also be willing and able to quickly answer each of these questions, and have processes in place to complement these key activities. A strong medical billing services partner is a team player and excited to be an extended part of your practice.

What Questions to Ask Your Medical Practice About Outsourcing Medical Billing

what to ask medical billing companies

When choosing to outsource your medical billing, your practice needs to establish your needs, scope, and strategy before engaging potential vendors and selecting a medical billing service provider that can meet your needs long-term.

What Should Stay In-House?

If you’re not sold on outsourcing all aspects of back-office operations, keep in mind that it is possible to maintain some aspects of medical billing internally. (For example, keeping coding in-house or customer service while taking a third party with claim submission and payer management.) Determine what areas you’re not ready to let go of, then find a billing firm that can adapt their offerings to fit your scope.

How Much Medical Billing Support Do You Need?

Are 9-5 service reps and a call-based escalation process enough for your organization, or do you need 24/7, always-on access to customer service professionals and billing specialists? Can one dedicated account manager rise to your expectations, or do you want multiple team-leads on your practice’s service engagement? Design your ideal outsourced medical billing model before pursuing a vendor contract.

What Are Your Medical Practice and Revenue Goals?

Practices outsource for a variety of reasons, just a few of which include decreasing errors and denials, lowering fixed overhead costs, or responding to changing needs in their internal staffing situation. For a medical billing service provider to serve you well, their staff will need to understand your motivations, circumstances, and objectives – so put some time into figuring them out.

How Will This Affect Your Patients?

Even though your front-desk team interfaces far more with your patients than the billing staff does, there may be certain interactions and decisions that your back-office makes now (such as write-offs and collections) that would be placed in a billing firm’s hands. Make sure that you prioritize your patients’ interests in your decision-making process.

What Are Your Liability Concerns?

When it comes to special healthcare practices like radiation oncology, there are many vital compliance and liability issues that hospital-based physicians and radiation oncology standalone facilities face on a day-to-day basis. And with growing pressures on reimbursements, the need to hire an outsourced medical billing company has never been more critical.

Medical Billing Outsourcing Checklist

Use this checklist when deciding which medical billing outsourcing services to choose to help your practice pick the right fit. 

5 Questions To Ask Medical Billing Outsourcing Companies

  • How Quickly Will They be Able to Begin Processing Claims?
  • What Services Do They Provide?
  • What Training Does Their Staff Receive?
  • Who Will Handle the Current Accounts Receivable (A/R)?
  • Will Monthly Financial Reports be Provided?

5 Questions To Ask Your Medical Practice

  • What Should Stay In-House?
  • How Much Support Do You Need?
  • What Are Your Goals?
  • How Will This Affect Your Patients?
  • What Are Your Liability Concerns?

Trust Your Medical Billing Processes to the Experts at NCG!

At NCG Medical, we’ve spent the past 40 years tailoring our medical billing services to meet the needs of many different practices, not just to assist with medical billing, but also to help maximize management potential and ultimately retain more revenue. Specializing in dermatology, gastroenterology, radiation oncology, holistic billing services, and more, we’re here to step in where we’re needed most. While some practices only need credentialing and contract management, others may need full-service revenue cycle management to get their practice on track.

We’re Dedicated to Providing Value

Some medical billing companies are quick to nickel and dime you with fees, inflated invoices, and other charges that don’t always seem worth the results you’re seeing. Our policy is to provide value instead. Just like an in-house employee, we’re committed to getting the maximum number of reimbursements possible for your practice. That’s why you’ll never see any upfront fees from our team, nor will we get paid unless you do first.

We Believe in Partnership

When it comes to outsourcing medical billing, both the provider and the outsourced company must mutually agree that the relationship is a partnership. Our U.S.-based tech support team is available to help with onboarding, to provide insight about importing charges, to report on financial performance, and to assist with any other questions you or your team may have.

There are many benefits to outsourcing medical billing, while still feeling like it's being handled in-house. At NCG Medical, we believe that our success is your success. From handling medical billing and coding to offering consulting services and much more, our team is dedicated to making it feel like we’re in-house.

Let Us Empower Your Medical Practice

With NCG Medical, you’ll get all of this and more. With a focus on physician practices, insurance background, and proven consultants, our team can effectively ensure the financial success of clients, allowing your medical practice to focus on what it does best: treat patients.

Our expertise is rooted in professional, technical, and global billing for hospital and stand-alone health care practices. We interface with systems like Elekta's Mosaiq© and Varian's Aria© to facilitate electronic data exchange of your charge information and use proprietary imaging and communication technology to interface with your practice or hospital staff to ensure secure data transfer. Additionally, NCG Medical is dedicated to the SSAE 18 auditing standard for service organization reporting by the Auditing Standards Board of the American Institute of Certified Public Accountants (AICPA)

To learn more about how outsourced medical billing with NCG Medical can empower your healthcare practice, contact us today. We’ll work with you to build a customized solution that meets the specific needs of your practice and allows you to get back to treating patients.

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