There is a back-end part of revenue cycle management. This consists of medical coding, billing which includes charge posting, claim review and submission, payment posting, AR (accounts receivable) management and collections. A complete revenue cycle management is complicated and does need specialists who understand the specialty, insurance rules and changes, state specific rules and other aspects that can affect the practice’s bottom line. This is where the outsourcing of medical billing can be extremely useful.
A quick overview of available research data shows that there is a growing medical billing outsourcing market.
Global Medical Billing Outsourcing Market Growth Highlights
The market size is projected to reach USD 23.1 billion by 2027, expanding at a CAGR of 12.3% (Grand View Research, Inc.)
The market size is expected to surpass around USD 23.7 billion by 2027 from USD 9.5 billion in 2019 growing at a CAGR of 12.1% from 2020 to 2027. (Precedence Research)
The U.S. market size is poised to reach USD 7.8 billion by 2026, exhibiting a CAGR of 11.0% during 2019-2026 (Report Linker)
INCREASE CASH FLOW
A competent cash flow management is crucial for practices to get properly reimbursed for the services provided. The right physician billing companies not only submit claims, but also follow up on those claims with health insurance companies for appropriate reimbursement. Do not let your AR get bigger.
MINIMIZE CLAIM DENIALS AND MAXIMIZE REIMBURSEMENT
VERIFY PATIENT’S COVERAGE AHEAD OF CONSULTATION
Patient eligibility verification is a key step in the medical billing process. With proper verification, you can understand all aspects of the patient’s coverage such as the type of plan that the patient has, the insurer responsible for payment, whether the coverage is active, coverage details, plan exclusions, specific coverage and more.
GET EXPERT SERVICE
Instead of training a team and preparing them for medical billing, coding, insurance verification and AR management, you can outsource these functions to a medical billing company that provides the services of skilled medical billing and coding specialists, insurance verification team, and other professionals.
IMPROVE CLINICAL DOCUMENTATION AND CODING
Expert AHIMA- and AAPC-certified coders can assign the most appropriate procedure codes, diagnosis codes, and modifiers, based on a clear review of medical records, pathology reports, and history and physical exam documentation. By outsourcing, hospitals and practices can benefit from experienced medical coders proficient in CPT, HCC, CDT, HCPCS, RAC, and ICD-10 coding. They can ensure that all the procedures and treatments are coded accurately on the medical claims.
GET PRIOR AUTHORIZATIONS ON-TIME
Some procedures require advance approval from insurance companies. Without prior authorization, the claim will not be paid. An insurance verification specialist can handle such tasks, as they are experts indetermining patients’ coverage and responsibilities before services are provided, which will reduce the chances of delayed or denied payments.
REDUCE OVERHEAD COSTS
When maintaining an in-house billing team, you incur costs such as salaries of the medical billing employees, payment for their healthcare, training costs, infrastructure costs, office space rental costs, software, hardware and material costs, and more, which could be financially challenging especially for small and medium-sized practices. By outsourcing, you can avoid such costs.
CREATE A POSITIVE BILLING EXPERIENCE BY AVOIDING ERRORS
Outsourcing helps to avoid common medical billing errors. With reliable support, you can avoid billing errors in electronic patient records such as wrong data entry or any mistakes in patient’s bills, upcoding, duplicate billing, unbundling, wrong demographic details, or failing to be up to date with constantly changing billing regulations and more.
BETTER DENIAL MANAGEMENT
Denied claims need to be successfully appealed. Experienced medical billing companies will have a dedicated team to appeal denied claims. The team would identify the actual reason for the denial, contact the insurance carriers,and perform a professional appeals process that includes sending the appeals with all the necessary information such as the patient’s name, claim number, date of service, member ID, and other relevant details.
Outsource Strategies International (OSI), Since 2002
With advanced software, strong business intelligent analytics, audits, and billing and coding expertise, we are well-equipped to help practices get appropriately reimbursed for services rendered.
Since 2002, we have been providing comprehensive medical billing services for diverse medical specialties, which include:
- Critical Care
- Emergency Room
- Family Practice
- General Surgery
- Internal Medicine
- Obstetrics & Gynecology
- Pain Management
- Physical Medicine & Rehab
- Physical Therapy
- Thoracic & Cardiovascular
- Oral and Maxillofacial
- General Dentistry
- Pediatric Dentistry
Our Service Highlights
Dedicated Billing Manager
System-Based Eligibility Checking
No Long-Term Yearly Contracts
Get Access To Our Web-Based Software All The Time
Regular QA Checking and Reporting
Customizable Reports Every Month
Quarterly Coding Updates
Weekly Meetings To Discuss Progress And Go Over Reports
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Will I have a dedicated team working on my account?
Yes. Our dedicated Account Managers will be your first point of contact. These experienced managers will assist with all your medical billing needs on a day-to-day basis. We understand that project integrity is maintained when the team works together. So, we assign a separate team of billing and coding specialists for each project.
With the right experienced team handling your account, you can stay focused on delivering excellent medical care to your patients.
What is your payment posting process?
How do you manage patient collections?
How do you ensure a smooth transition of my process?
We take certain steps to ensure that all required details are collected even before the transition takes place.
- We gather information from your office that will include all aspects of your present billing and collections cycle
- We evaluate your current billing practices to identify gaps, shortcomings and other issues
- Based on these metrics, we create an appropriate, effective and more efficient solution
- We finalize our plan after discussing it with you and then educate your staff on the processes they will be responsible for
- We will ensure that our billing and collections department understands the protocols and rules that you have set in place along with other specifics concerning the practice
- A few dry runs will be conducted to make sure every area in the billing and collections process functions properly and that all expectations are met
- We will have staff, software and everything on hand to ensure a smooth transition
How do I keep track of my practice performance?
We provide performance reports to our clients such as weekly collection reports, denial reports,and month-end reports that include physician financials, procedure code usage reports, collection by carrier reports, aged summary reports, detailed management summaries, and year-to-year analysis. We assure that the informative medical billing reports we provide are accurate and easy to follow for proper financial analysis and comparisons. We assess your billing collections performance by comparing your practice to industry benchmarks.
Insurance verification - what details do you verify?
How do you work with your clients? Do we have to give you our whole revenue cycle management to start with you?
What is your turnaround time?
When it comes to scheduling, medical coding outsourcing, payment posting or any other area of RCM we remain flexible to adjust the turnaround time to your needs. In eligibility verifications we can work on future appointments as well as STAT requests and add-ons keeping you 3 to 5 days ahead of schedule.
Depending on which area of medical billing outsourcing you are interested in, we can provide quick turnaround times from immediate to 2, 4, or 24 to 48 hours. Like we mentioned earlier, tell us what your reasonable expectations are, and we will make sure our service level agreements are constructed accordingly.
We realize that when it comes to revenue cycle management with medical billing outsourcing, it is a very tough and an involved decision for any practice. We want you to feel comfortable with making your choice. This is why we offer free trials for some aspects of our services.