Revenue Cycle and medical billing have evolved tremendously in the healthcare industry. With the advent of COVID-19 and the increase in Telehealth and Telemedicine codes, many healthcare providers and facilities have seen a great decrease in revenue and patient care. In addition, constant changes in reimbursement fee schedules that cause poor cash recoveries and weak net revenues are some of the pain points contributing to the issues facing the industry. Similarly, provider credentials such as in-network vs out-of-network or participating provider vs non-participating provider are additional factors that affect cashflow. As a result of these factors, the quality of care and time spent with patients has declined.
Now comes the question: How does one get paid for the services given to patients? For many health care providers, they are faced with the dilemma of documenting and coding error-free claims that must be sent to clearing houses in a timely manner.
So, who should cater to your billing needs? In-house or outsourced billers? Let’s take a look at some of the Pros and Cons of each group.
Pros and Cons of Outsourced Billing: Before billing, outsourced companies utilize an analytical focus to identify the patient demographics and review claims to ensure the correct codes and documentation are used.
Typically certified coders and have the experience to submit claims with quick payment turnaround times
Experts in coding and billing with proper documentation that boost revenue for care providers and are accustomed to the continuous updates in ICD-10 codes and CPT codes
Conduct fee reviews and pre-authorizations for procedures to maximise reimbursement, as well as thorough research on claims to reduce denials and ageing reports
Efficient in practice management processes by entering claims, doing appeals, and submitting claims on time
Finding a good outsourced company can be difficult, time consuming, and even costly
Some cases require specialist to bill complex procedures
Pros and Cons of In-house Billing:
It can be done right after services or procedures are documented
Doctors and nurses are at hand for documentation and peer review
Often times, office staff have to multitask which results in a lack of expertise
Sick leave causes delays in processing claims
To cut costs, companies often hire inexperienced billers or coders which leads to loss of revenue, a high volume of denied claims, and unnecessary time spent on follow up calls to insurance companies
Training medical billers and coders are costly and takes years. However, based on the information presented, it is clear that training and/or hiring experienced billers and coders can prove to be an invaluable investment that ultimately generate more revenue in the long-run. At the end of the day, outsourced medical billers are a wonderful solution. They help medical staff spend more time taking care of patients and less time answering financial questions and battling denied claims. In addition, outsourced companies can handle credentials and negotiate contracts with insurance payers for health care providers to ultimately boost revenue for practices. So, in short, leave it to the experts to generate higher revenues by ensuring quick reimbursement payment turnarounds with fewer claim denials. At SueHealth Solutions LLC., we focus on providing impeccable services to our clients by guaranteeing that in-depth compliant improvements are made, clean claims are submitted, denials are reduced substantially, and so much more. With AAPC and AHIMA certifications and over 16 years of experience in medical billing and coding, SueHealth is the right choice for all of your practice's medical billing and coding needs! Find out more about how we can help at https://suehealthsolutions.com.