Successful management of medical claims is crucial to improve cash flow and patient satisfaction in any healthcare specialty. An analysis published in Healthcare Finance finds that the average 350-bed hospital misses $22 million in revenue capture opportunities. Medical billing outsourcing is a great option for physicians to save time for better patient care, reduce their administrative tasks, process claims faster, and ensure billing compliance. Most common medical billing errors include using incorrect medical codes, inaccurate patient eligibility and insurance verification, and wrong patient details.

Market Analysis

According to the latest report from Absolute Reports, the global medical billing outsourcing market is expected to register a CAGR of 10.5% during the forecast period, 2018 – 2023. This market includes services such as insurance eligibility verification and pre-authorization, medical coding, charge entry, accounts receivable follow-up, denial management and more.

Key factors that boost this market’s growth are

  • growing emphasis on compliance and risk management
  • increasing need to make billing processes efficient
  • efforts to contain and decrease in-house processing costs

However, certain factors that restrain the growth of this market are increasing legislative, regulatory pressure as well as high costs of technology. It has been noted that despite having a certified EHR system, associated costs for all payer sources such as Medicare and Medicaid provide challenging nuances on claim adjudication requirements in hospitals.

Based on the report, key manufacturers of this market include Accretive Health, Allscripts, Cerner Corporation, EClinical Works, Experian Information Solutions Inc., GE Healthcare, Genpact, HCL, Kareo, McKesson Corporation, Quest Diagnostics and The SSI Groups Inc among others.

Based on geographical regions, the market is divided into U.S., Canada, Mexico, France, Germany, UK, Italy, Spain, China, Japan, India, Australia, South Korea, GCC, South Africa, Brazil, and Argentina. Owing to rapid changes in healthcare structure reflected by the implementation of the new ICD-10 medical coding system as well as pressure from the government to implement EMR management system, North America is expected to dominate the market during the forecast period. Changing regulations coupled with rising healthcare costs are major growth drivers for the market in this region.

MA Plans Improperly Denying Many Medical Claims

Even with such outsourcing options available to reduce claim denials, private plans may still deny medical claims to patients as well as physicians.

The New York Times recently published a report, wherein federal investigators at the Department of Health and Human Services point out that Medicare Advantage plans, the popular private-insurance alternative to the traditional Medicare program, have been improperly denying many medical claims to both patients and physicians. This report finds that “the private plans, which now cover more than 20 million people – more than one-third of all Medicare beneficiaries – have an incentive to deny claims in an attempt to increase their profits”.

Outsourcing tasks related to medical claims and revenue cycle management to an experienced medical billing company can provide more peace of mind to physicians, while they focus on providing better treatment to patients.