Healthcare

In-House Vs. Outsourced Medical Coding and Billing: What Are the Differences?

For medical practices, especially those that are small or medium scale, an effective revenue cycle management (RCM) is vital to ensure healthy cash flow and the overall success of the organization. Due to the complexities of billing and revenue collection in healthcare, business owners and health practitioners should definitely invest in their RCM teams to prevent costly errors and increase claims efficiency.

Two of the main processes involved in RCM are medical coding and billing. The roles of medical coders and billers often get interchanged, but their responsibilities are different. A coder is tasked to review medical documentation and assign them diagnosis and procedure codes to be used for reimbursement. On the other hand, a biller is in charge of arranging payments and submitting claims to insurance companies or other payers as well as following up on rejected claims and billing patients directly.

Depending on preference, budget, and business needs, one can choose to have these RCM functions done in-house or outsourced from a provider. Read on to find out what is better for your practice.

In-house

Building an in-house team of medical coders and billers is advantageous in terms of having direct and hands-on control over your RCM processes, which also gives you the chance to test out new methods that you perceive to be beneficial to your RCM and your organization in general anytime. Moreover, having an in-house team allows you to address billing-related problems and issues faced by your staff immediately since you are all technically in the same place. 

Establishing an in-house RCM team with expert medical coders and billers, trained staff, and a solid billing infrastructure is regarded to be a great investment for your organization in the long run. When you have this, all that is left for you to do is refine your operations to the best of its ability and you will have an effective RCM.

Of course, just like other things, there are also downsides to in-house RCM. For one, building a team can entail high costs, which can be a burden particularly for small organizations. Additional expenses for salary and benefits will occur for every new personnel in your team and you also have to spend for the necessary billing software and training for your staff. Given this, it will be challenging financial-wise to recruit more people, which means you are likely to have a limited number of personnel. In case of emergency, this can put you at risk of stalled operations.

Lastly, both medical coding and billing are time-consuming and tedious processes that can take the focus of your staff away from actual patient care, which can be detrimental to your operations and business. This is why outsourcing RCM has become more popular at present.

Outsourced

At first look, the most obvious benefit of outsourcing medical coding and billing is cost-cutting. According to a 2020 Black Book report, approximately 90% of hospitals have already outsourced or are planning to outsource their RCM functions to reduce overhead costs. By outsourcing, you’ll be able to save on recruitment and administrative expenses, which you can then allot to more revenue-generating activities.

You also save time in hiring, training, and managing coders and billers and give more attention to enhancing patient care and improving your practice when you opt to outsource. Moreover, the right partner will give you access to RCM professionals who have the industry experience and required skills to ensure that all your billing-related processes are handled properly to minimize errors and to ensure all payments are made on time.

While outsourcing can feel like you have lesser control over your processes, you can always request for comprehensive performance reports for more transparency in operations. Other drawbacks of outsourcing RCM include variable cost and hidden fees, which can be prevented by studying your contract thoroughly and talking with your service provider before you ink that partnership.

Outsourcing has always proven to be a beneficial strategy to improve business operations, especially in the healthcare industry. The key is to just find the right partner that can provide the following gains:

  • Operational excellence
  • Build a dedicated team healthcare team (i.e. RCM)
  • Operational savings of up to 70%
  • Access to world-class talent
  • A+ recruitment process
  • Industry experience
  • HIPAA and DPA-20212 compliance
  • Net Promoter Score: Sense of security and peace of mind

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performing RCM team composed of:

  • Medical Coders
  • Medical Billers
  • Patient Concierge
  • Clinical Abstractors
  • Patient Concierge
  • Medical Review Specialists
  • Care Navigators
  • Outbound/Inbound Collections
  • Other RCM Teams
  • Other Healthcare Support

Let’s work together to build a great RCM Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

2 weeks ago No Comments Views

Where to Find Claims Processing Experts

For healthcare providers, managing complex interactions with medical insurance companies can sometimes take away the focus on providing excellent patient experience. This is why having experts handle these kinds of transactions is important not only to ensure efficiency in operations but to prevent common errors and noncompliance to regulations.

Claims processing in particular is a tedious and complicated task that involves reviewing claim submissions, obtaining and verifying information, corresponding with insurance agents and beneficiaries, and processing claim payments. With their knowledge and expertise, claim processors can manage these responsibilities well, eliminate backlogs and tighten turnaround times.

One of the best ways to have them in your team is through outsourcing. A dedicated outsourced team of claims processing experts who have an intimate experience with revenue cycle management will create customized solutions for your company and adapt to your processes while improving them when they can. When you outsource your claims processing experts, you can also enjoy the following benefits:

Streamlined and more efficient claims processing

Adding an outsourced claims processing team in your operations means you have a dedicated set of people that can help you handle a high volume of transactions and reduce processing time with the use of automated and streamlined processes. In turn, this maximizes your team’s output and the rest of your staff can focus on delivering the best care to your patients and other tasks that can help in the improvement of your company.

Improved patient satisfaction

Outsourcing providers have the experience, expertise and resources when it comes to managing challenges that come with claims processing and you can use these to your advantage to improve your customer service. With an outsourced team devoted to handling claims processing, turnaround time will be faster and claims are handled with greater accuracy. Each client will also be given closer attention regarding their concerns and queries by your claim processors – all of these resulting in greater patient satisfaction.

Lowered operations costs

By outsourcing your claims processors, you are able to cut the expenses that come with hiring in-house talent including benefits, salary, and training without compromising the quality of service. There’s also no need to invest in the necessary technology and infrastructure for the role since the right outsourcing provider has the resources and tools to help streamline and automate the claims processes.

When looking for a trusted outsourcing company, partner with the one that can help you build a dedicated claims processing team that has:

  • Access to world-class talent
  • A+ recruitment process that can hire and on-board new teams within 30-45 days
  • A high Net Promoter Score of at least 60

Net Promoter Score (NPS) helps businesses gauge the quality of the customer service offered by outsourcing companies. Organisations can use NPS to assess which outsourcing service is best to partner with because this score shows loyalty trends and growth revenue outputs.

In a way, NPS represents the primary way customers survey their experience because it means that their clients are happy which results in customer loyalty and retention, making this a critical trait an outsourcing company should have. When used correctly, NPS (of at least 60%) can tell you how well the BPO is performing, how often they resolve issues, and if their clients are satisfied with their experience.

The right partner will guarantee you:

  • Operational excellence
  • A dedicated team of RCM experts
  • Operational cost savings of up to 70%
  • 95% coding, billing and documentation accuracy
  • 90% ROI in correct claims processing
  • Improved denial management rate
  • ISO 27001 and 9001 certified, GDPR, HIPAA compliant
  • Net Promoter Score >60: Sense of security and peace of mind

Partnership with Infinit-O
Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performing RCM team composed of:

  • Claims Processors
  • Medical Coders
  • Medical Billers
  • Patient Concierge
  • Clinical Abstractors
  • Patient Concierge
  • Medical Review Specialists
  • Care Navigators
  • Outbound/Inbound Collections
  • Other RCM Teams
  • Other Healthcare Support

Let’s work together to build a great RCM Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

1 month ago No Comments Views

Healthcare Business Stability: Expectations Vs. Reality

Organizations that are in the business of providing medical services, medical insurance, medical equipment, and drugs are usually considered profitable and stable. However, like all other businesses, they too have a unique set of challenges inundating them at every step towards viability.

Success for them means ensuring efficient financial management so that they have enough to carry out everyday activities without looking towards creditors for an injection of cash. They must also have the means to replace or add expensive equipment to their repertoire depending on the needs of their processes.

However, despite these similarities, they differ significantly from other industries in several aspects. For starters, in the healthcare industry, the person who buys the service is not necessarily the one who pays for it. Instead, they often work with insurance companies and government programs to set prices and extract payments for services and products provided.

This mandates the need for timely market dislocation and comprehensive record-keeping solutions to keep the medical industry in business.

What Threatens The Stability Of Healthcare Businesses?

Environmental changes and dynamic government policies are often the biggest influencers for businesses in this niche.

At the same time, the structure of modern healthcare businesses is based on technology and procedures that don’t lend themselves well to relationship building with the end-consumer. As a result, professionals in this niche don’t have the time to support the inquiry, reflection, and communication needed for health promotion and disease prevention.

Additionally, virtually all states are legally responsible for monitoring the quality of services provided across public and private sectors. Unfortunately, this results in regulations that increase the costs for healthcare businesses and create high-profile troubles that lead to stagnancy in the healthcare delivery system across the nation.

Similarly, disease outbreaks like the coronavirus pandemic affect all businesses, but the healthcare sector faces the brunt of the impact. So, in times like this, how does a healthcare business sustain itself?

Exploring The Sustainability Of Healthcare Businesses During The Pandemic

As healthcare organizations prepared for a surge of hospitalized patients in the wake of COVID-19, they couldn’t have predicted the extent of the damage it was about to cause for their businesses.

They had to spend more on hiring a backup workforce, obtain protective equipment, set up negative pressure rooms, and amp up the production of essential equipment and drugs. At the same time, social distancing practices made it almost impossible to work at full capacity as many elective procedures and surgeries were altogether canceled.

Here’s what entailed:

The Unprecedented Numbers

Expectation

The first case of Coronavirus was found in 2019, and it was expected that it would turn into a pandemic. Researchers believed that it could overwhelm hospital and intensive care unit capacities for healthcare providers across the nation.  

Reality

The reality turned out to be far scarier as COVID-19 became the third-leading cause of death in 2020. In addition, it led to a $3.3 trillion deficit in the same year, i.e., about 15% of the US GDP.

Financial Solvency Challenged

Expectation

The American Hospital Association estimated a financial impact of $202.6 billion in lost revenue for US healthcare systems.

Reality

The median healthcare provider had 53 days cash-on-hand and 49 days in accounts receivables. But the raging pandemic rendered many of their debtors unable to pay, threatening the financial solvency of businesses that offer care delivery and billable services. Soon, due to lack of economic instability, 1 in 5 rural hospitals was at risk of closure.

Shocking Lack Of Preparedness

Expectation

The US administration was quite confident early on that they were adequately prepared to provide for the protective needs of the healthcare professionals. They sent 18 tons of PPE, gowns, masks, and respirators to China.

Reality

It turns out; things soon got worse at home as healthcare facilities struggled to find personal protective equipment (PPE), sanitizing supplies, toilet paper for their own staff. This deficiency exposed the reality of pandemic preparedness across the country.

Outsourcing – The Saving Grace For Healthcare Businesses

As the effects of the pandemic show, it is difficult for healthcare businesses to maintain their stability. For this reason, many medical companies turn to healthcare outsourcing.

Following are the top reasons to outsource medical billing and more:

Cost Savings

Instead of focusing on monthly salaries, workplace infrastructure, and managing billing software, you can focus on the business at hand. Meanwhile, billing experts know how to manage finances and maintain liquid assets appropriately. In addition, they lead to less overhead costs and faster approvals, improving financial stability.

When you outsource medical billing, you assign financial responsibilities to an experienced third party that can handle billing rejections, file re-bills, and has the latest technology to provide adequate financial assistance.

Compliance With Changing Regulations

Compliance in coding and charting is essential. But you can only adhere to compliance requirements and professional reporting when you have knowledge and expertise in the area.

This is where medical coding outsourcing proves vital. Instead of stressing about following updated compliance guidelines, you can focus on the administrative work and leave the financials to the experts.

Business Maintenance And Growth

By maintaining records and employing strategic practices, a medical billing agency facilitates business growth. This means they provide you with effective billing solutions to increase revenue.

Ultimately, this enables you to purchase the latest equipment, make better hiring decisions and ensure business stability even during times of crisis.

Summing Up

Since healthcare businesses are impacted by various changes in the natural and social environment, they must learn to adapt quickly.

But maintaining financial stability, especially during a crisis like the coronavirus pandemic, is not easy. The problem is exacerbated when medical businesses are tasked with many activities at the same time. It is where healthcare businesses can seek the aid of third parties by outsourcing their medical billing and other functions to experienced professionals. 

All these qualities and more can be found with the right outsourcing partner who can provide a customized, high quality healthcare business solutions that can promise for the following:

  • Operational excellence
  • Build a great healthcare & RCM team specifically designed for your unique needs
  • Operational cost savings of up to 70%
  • Information and data security
  • Sense of security and peace of mind

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Patient Support Services

  • Patient Concierge Specialist
  • Insurance Verification Specialist
  • Collections Specialist
  • A/R Specialist

Provider Management Services

  • Medical Coders
  • Medical Billers
  • Claims Processors
  • Enrollment Processors
  • Denial Management Specialist

Health Analytics and Risk Management Services

  • Healthcare Analyst

Others

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

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