Medical Billing Outsourcing – How to Make it Successful?

Outsourcing medical billing has caught up hugely with providers as it is the most cost effective option for at least maintaining a steady revenue if not increase it. Bottom-lines of medical practices are sinking due to various reasons and it is one of the most worrying issues for practices currently. For ensuring guaranteed results, healthcare providers should select an appropriate and able medical billing partner. Here’s how you can do it:

1. Experience in Handling Specialty Expertise

There are some peculiarity in every medical billing for different specialties. It is essential to handover your billing process or the revenue cycle management (RCM) to a billing company that has the workforce to handle your specialty. The checkpoints should include the size of their team in accordance to your billing requirement, experts on panel dedicated for you, experience and qualification of the billing staff, and so on. You may also ask for their performance reports to validate their claims.

2. Knowledge of Billing Compliance Measures

A physician should try to find out how the billing company deals with the changing compliance issues in the wake of constant healthcare reforms, what are the measures they take to observe HIPAA guidelines, their expertise in operating different practice management and billing software, their contribution in the transition process, the corrective actions they take in the event of some lapse or error, etc. A billing partner should ideally help in training your in-house staff to get acquainted with the operability and features of the software.

3. Current Healthcare Industry Updates

A quintessential quality of a good outsourced billing partner is their diligence in staying abreast with the reforms and updates taking place. Apart from being updated themselves they should also extend a helping hand in updating your in-house staff about the new implementations. For example, meaningful use (MU), helping providers participate and qualify for government incentive programs, the changes they make in the RCM process to enhance cash in-flow, etc.

4. Status of Payer Rules and Regulation

Payers have various healthcare policies designed for different age groups of citizens but what is more varied is their billing compliance rules, the timeframe specified for filing claims, following up on account receivables (AR), the explanation of benefits (EOB), appealing denials, etc. The biggest advantage of outsourcing medical billing is tapping the potential of dedicated billers with respect to their experience and rapport with different payers. Their panel of experts analyze the reimbursement trends of different payers which proves worthwhile for ensuring maximum revenue collections.

5. Deliverables and Performance Monitoring

Clarity in your demand and availability of their supply is prime in case of outsourcing to a business partner. Before initiating communication with any billing company you should have your requirements written in front of you. It is important to be as transparent as possible when laying the terms of the agreement to avoid wastage of resources and also to ensure that both of you are on the same page.

What should follow is the periodic performance reports of your billing cycle with detailed inputs from the billing partner on how your medical practice can improve the collections further or coin solutions to streamline the bottlenecks and ensure a steady and smooth revenue cycle.

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