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How Can Outsourcing Medical Billing Requirements Reduce Claims Denial?

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Last modified on September 22nd, 2022 at 11:18 am

medical billing services

Most of the revenue loss physicians and other medical professionals experience in the United States can be attributed to claim denials. One of the essential variables in a medical practice’s financial health is the quality of its medical billing services. Repeated denial of claims can drastically affect the financial health of medical practice. Almost any claim denial reason is a result of substandard medical billing processes. In some cases, there is no SOP for denial management, and the revenue loss for such medical practitioners can be huge. By contracting out for medical billing services, you can entrust this crucial part of your business to the hands of experts. This post will go over the technicalities of outsourcing medical billing and how it can be an excellent practice for your business overall. 

What is Medical Billing?

When healthcare practitioners and organizations perform services for patients, they must go through a procedure known as medical billing to be reimbursed for their efforts. Medical billers are responsible for converting healthcare services into billing claims and then following up on those claims to guarantee payment to the organization. The financial health of a medical practice or healthcare facility can be improved by hiring an experienced medical biller.

It is essential to acknowledge that while they are related processes, medical billing and medical coding are not the same. To decipher physician notes and operation reports, medical coders and billers need a firm grasp of medical terminology, anatomy, and pathophysiology. Medical coders may work for billing firms or independently to assist with billing. In smaller medical facilities, it is customary for one individual to take on both the medical coding and billing responsibilities. Even though they serve different purposes in the healthcare revenue cycle, billing and coding are essential.

Benefits of Outsourcing and Effect on Claim Denials 

Efforts to outsource medical billing services are commonplace these days. By outsourcing your medical billing, you can access certified billers, lower your risk of denials, boost your reimbursements, and stop revenue loss. To increase billing accuracy and achieve industry-leading results, healthcare providers must work with the best service providers. Here are some of the benefits that can be attributed to outsourcing medical billing: 

  1. Reduction in billing errors 
  2. Improves cash flow and overall financial health 
  3. Ensures compliance and regulatory support
  4. Improves patient satisfaction
  5. Help cut costs 

All these factors go a long way in helping decrease the claims denial rate. Professional medical billers are familiar with the intricate procedures involved in submitting claims. Companies specializing in medical billing ensure their employees have undergone extensive process training and passed the necessary quality and domain-driven knowledge testing. These medical billers are responsible for submitting claims promptly while ensuring accuracy. In addition to lowering the percentage of denied claims, they also edit claims for errors before sending them to the payer. A good outsourcing partner will constantly ensure compliance is thoroughly ingrained in all processes. 

Outsourcing Medical Billing Requirements: Key Considerations and Tips

Capital Investment 

The capital investment involved in establishing a billing department is considerable. While working with an offshore medical billing partner, you need not tie your valuable business capital up. In addition to this, setup, payroll, benefits, and severance costs are expenditures that will increase as you attempt to scale. While working with a medical billing partner, you aren’t obligated to make any such investments. 

Improvement in Outcomes

Medical billing outsourcing improves revenue cycle management. You can obtain payments faster when your medical billing process is up-to-date, efficient, and error-free. The detailed performance reports will inform you if your medical biller is transparent. You maintain control of your revenue cycle management without doing the work. Many pharmacy billing services partners also offer payment terms where they only make money when you do by taking a percentage of total claims processed. This ensures that they have enough skin in the game. 

 Transparency in Reporting

No matter how much of the medical billing process you have outsourced, keeping track of your claims is still essential. Moreover, the decision ultimately rests with you. Your billing partner must update you on their progress and what they’ve done on your behalf through regular, clear reports. This does not necessitate micromanagement but rather a watchful eye over the billing procedure to guarantee accuracy and ensure that all the necessary protocols are followed. 

Compliance and Regulations

Healthcare privacy and security are your responsibility. After outsourcing to a HIPAA-compliant organization, you may rest easy knowing that the company’s processes preserve patients’ health information and legal rights. Your outsourcing supplier should follow HIPPA and other medical requirements. This helps you maintain high-care standards and ethics, eliminate fraud, and enhance your revenue cycle.

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