Offshore outsourcing medical billing is becoming the right choice for many healthcare institutions and private practices. Outsourced medical billing not only helps organizations reduce operational costs, it also increases revenues and allows health professionals to focus on providing high-quality care to their patients. Here are some offshore outsourced medical billing case studies and success stories:
A radiology management group in the U.S. East Coast was struggling with many billing-related issues: improper dictation, backlog of outstanding charges. These needed to be entered into the management software, and poor quality images that led to entry errors. The radiology practice, which serves multiple groups of physicians, decided to work with a medical billing outsourcing firm for charge entry, demographic registration, medical coding, and A/R (accounts receivables) follow-up.
The outsourcing firm worked closely with the client to identify key issues to solve. The firm improved image resolution to reduce charge entry and demographics errors. They organized medical reports for easy retrieval and suggested improving dictation reports to increase reimbursements. They also deployed a quality assurance team to validate processed files. The operations and IT teams worked together to create a tool to improve accuracy, efficiency and productivity. Daily productivity reports were sent to the client along with regular updates on specific insurance company policies.
Because of the outsourcing partnership, the client was able to process about 7000 CPTs on a daily basis with very minimal errors (0.5 to 0.75 percent). The number of clean claims billed to insurance companies increased significantly, and turnaround time was reduced. The client was able to understand financial trends better due to data-driven reporting provided by the outsourcing firm.
A private family practice wanted to improve tracking of patients that were on and off protocol, and implement an operational procedure to make sure protocols were followed. The client also needed a reporting tool that would easily integrate with their existing EMR software. The client worked with an established medical solutions provider to obtain the technological resources needed for the project.
The service provider enlisted the help of software vendors to rework and organize the old data set and integrate the new information into the custom reporting tool via EMR. The new data showed in detail which patients were on and off protocol, the actions required to bring patients back on protocol, and which members of the staff needed to be trained to follow protocol.
As a result of the reporting system, the private practice increased the percentage of patients on protocol from 60 to 90 percent. The reconciliation and paperwork time was drastically reduced from many weeks to less than two hours. By keeping patients on protocol, the firm also increased revenue on diabetic patients by over $2500 every month. Another benefit of the outsourcing partnership was mitigating litigation risk for patients off protocol.
An internal medicine practice was having difficulty driving revenues due to inefficient workflows and claims not being posted on schedule. The practice decided to work with a medical management outsourcing firm to address these key issues. The service provider found a high number or claims not being worked in a timely manner and claims being written off, leading to poor collection rates for the practice.
The outsourcing firm took over the client’s entire billing process, stabilizing the cash flow within three months and increasing collection percentage by over 9.8 percent within one year. The client’s A/R cycle was also reduced by 11 days, leading to improved revenues and profitability. Besides these improvements, the outsourcing firm developed custom reports, including reimbursement analysis, to generate data and insights to improve processes for the long term.
Outsourced medical billing services range from simple, low-level tasks like data/charge entry and scrubbing to end-to-end revenue cycle management and strategic consulting and planning. Most organizations outsource only part of their billing process, holding on to certain activities. However, the number of businesses using end-to-end revenue cycle management is expected to increase, driven by the needs of larger companies seeking more value from outsourcing relationships.
In general, the outsourced medical billing process is straightforward. The third party firm provides capture and entry services, gathering claim information from electronic or paper patient records. The documents are scanned and sent to the billing team for validation and processing. If the practice is using EMR software, information can be sent electronically to outsourced billing team and to the insurance company.
Third party medical billers provide and utilize necessary software to streamline the billing process. They are responsible for submitting claims to the insurance company, following-up on these claims, sending invoices to patients, appealing denied claims, managing delinquent accounts, posting payments, and handling financial calls from patients. As payment for their services, the outsourcing firm usually takes a cut from the practice collections. The industry average is about 7 percent for a claims processing service.
When planned and managed properly, outsourced medical billing can transform healthcare organizations. However, many practice owners, physicians and managers are unsure how to make the case for outsourcing or whether the business can really benefit by offloading billing tasks to a third party provider. The alternative to outsourcing is building a billing and revenue cycle management team in-house, which has its own pros and cons.
For small practices and healthcare organizations that lack resources, outsourcing billing and accounts receivables (A/R) to an outside specialist makes the most sense. For larger or expanding practices, building an internal medical billing department can mean more direct control over processes. There is no one-size-fits all solution, and the best way to determine whether outsourcing can help achieve your goals is to take an honest look at your business. Careful evaluation will uncover issues and opportunities and help you decide whether parts of your revenue cycle or the entire process can be better performed by someone else.
Analysts recommend strategic planning of your outsourcing campaign with traditional cost-benefit analysis as well as identifying resources and using them in such a way as to drive competitive advantage. Determine whether outsourced or in-house medical billing can help your business deliver long-term value for patients and drive profitability by giving you a competitive edge.
Cost remains the top reason companies across industries outsource certain functions. The same is true for medical billing. For many practices, working with a third party that provides medical billing services can reduce their total costs significantly. For a “typical” in-house billing department, industry experts expect a 60 percent gross collection—the practice collects 60 percent of what it bills. An outsourced billing provider, on the other hand, is expected to increase the gross collection percentage to about 5 to 15 percent.
In-house billing means investing in the right hardware and software per employee. A typical practice can spend over $10,000 on hardware and software (upfront cost of a software system not included). With outsourced medical billing, the third party provides or develops necessary tools that can be integrated with existing ERM software, thus reducing overall IT costs.
Skilled Medical Billing Professionals
Building an internal billing department is expensive for any company. Labor costs, benefits, taxes, training/support and human resource expenses for two medical billers can easily exceed $100,000. Finding skilled medical billers can also be a problem in certain areas. Outsourced medical billing can cut these costs drastically through economies of scale and by leveraging high-quality, low cost talent in emerging locations. Many practices find that outsourced medical billing provides immediate access to the best professionals who are committed to their success as much as they are.
Based on these comparisons, outsourced medical billing is an effective strategy for its potential to increase the percentage of collections and for providing immediate access to skilled medical billing professionals and best-in-class technology. However, working with a medical billing outsourcing firm makes sense only IF the firm improves collection and revenues.
Every practice is different, and solutions must be customized to fit changing business needs. Not all practices want to reduce costs; many healthcare organizations want to improve inefficient processes. For example, an in-house EMR tool that integrates into the company’s current management software can reduce errors and duplication significantly, while increasing transparency and revenues.
Practices that are ideal candidates for medical billing outsourcing are those that need to:
A new practice or business can also benefit from outsourced help. Medical professionals and new business owners have a lot to learn about admin tasks and running an efficient in-house billing operation. While it’s important to understand the basics of medical billing, a medical outsourcing provider can fill the knowledge and skill gap to drive profitability, while physicians and medical professionals focus on providing high-quality patient care.
The decision to outsource medical billing ultimately depends on the company’s goals. In general, studies show that outsourced billing provides higher net return compared to in-house billing. The key is to develop an outsourcing strategy that addresses priority issues, keeps costs down, increases profitability, and improves the quality of service.
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