Medical billing has always been a highly specialized field, perhaps never more so than in the current era of healthcare reform. Billing technologies are changing, and the ever-increasing regulations and record keeping red tape require ever more attention to revenue management. With profit margins shrinking due to lower payments and higher compliance costs, it makes sense for many practices to embrace the economies of scale that come with outsourcing your medical billing services .
After all, efficient revenue cycle management is more than just good business sense, it's often a matter of survival. Here's a look at where economies of scale pay off in medical billing.
1. Medical Coding Expertise
Too many practice managers make the mistake of assuming the ICD-10 transition is all about the impact on the revenue stream and issues surrounding the cost of transition. In truth, however, the real impact is in compliance, first from a quality and medical necessity perspective, and later, in surviving the inevitable audits that will result from an aggressive enforcement regime. The 12-month CMS grace period on quality penalties and claim denials for Medicare Part B is a clear indicator of the enforcement audits to come.
Medical billing staff need a high level of training in order to properly evaluate a medical record to ensure the documentation exists to support reported codes. This level of specialization is available to practices outsourcing their coding, billing, and medical documentation in a way most small to medium-sized practices could never maintain in-house, protecting them against both short and long-term risks to their revenue stream.
2. Access to Specialty-Specific Expertise
Multi-specialty practices are often at a disadvantage when it comes to optimizing billing processes across the organization; to maximize revenue, each specialty could benefit from its own dedicated billing specialist. For all but the largest groups, however, that level of specialization isn't possible in house.
For example, Medicare in 2016 is bundling CPT codes for several interventional radiology procedures, resulting in significantly lower reimbursements across the spectrum for these services, in some cases up to 70 percent or more. At the same time, it has assigned new codes to previously unlisted procedures that somewhat offset these losses if documented and billed correctly. It's difficult to get that level of expertise and specificity in a small in-house billing department. A billing service representing a larger number of physician specialists, however, will invest in staff training to maximize revenue.
3. Cleaner Claims, More Accurate Payments
Improved cash flow, in the form of faster turnaround, fewer denials, and a high rate of claim resolution, is one of the major advantages a billing service offers medical groups. Claims are checked for errors prior to submission using the best claim scrubs, adhering to the best policies and procedures for each carrier, and billing services are set up to accept ERAs for the fastest turnaround.
Payments are reviewed in a timely manner by billing professionals who can quickly and easily recognize incorrect adjustments and write-offs and take steps to recover them. Rejections and denials are worked in a timely manner by staff whose only role is claim resolution. Errors in payment posting are infrequent and detected quickly by a stringent QA process, speeding up patient billing and collections.
At each step, a billing service is able to offer a higher level of expertise at a lower overall cost than most medical practices can achieve with in-house staff, due to economies of scale. Contact M-Scribe today to see how your practice can improve collections while lowering costs by outsourcing your revenue cycle management.