If your medical practice has been handling billing in-house, the increasing complexity – including the switch to ICD-10 – might have you thinking about outsourcing this important function.



Perhaps you’re looking for ways to reduce expenses, or you’re wondering if outsourcing this important function. Perhaps you’re looking for ways to reduce expenses, or you’re wondering if outsourcing billing and collections to a third party would improve your bottom line.

Hiring a medical billing company offers many conveniences but you’ll need to weigh the pros and cons carefully. What makes sense for one practice won’t work for another – plus there’s the matter of choosing a vendor.

When Does Outsourcing Make Sense?

Consider these factors when making your decision about outsourcing billing and collections, also referred to as “revenue cycle management,” or “RCM.”

  • Staffing costs: RCM is fairly labour-intensive. Even a small practice of one to three physicians needs one or more dedicated staff members to handle the volume of claims. The cost of salaries and benefits is likely to be higher than the expense of hiring a billing company. Turnover may also be an issue: it takes time to hire and train new staff. On the flip side, you may have a very capable, well-established in-house team that understands the nuances of your practice – and that may be worth the extra cost.
  • Technology: Handling your billing in-house requires an up-front investment in technology, including computers and medical billing software or practice management software. You may also have to pay for staff training. Ongoing cots include IT support, software upgrades, and reference materials such as coding book. In-house billing also requires office space and storage space for your billing records.technology-tools
  • Efficiency: Outsourcing billing and collections may make sense if your in-house processes aren’t very efficient and collections are falling behind. A good billing service can also provide a snapshot of your accounts receivable when requested, something that your time-strapped staff might not be able to do.
  • Complexity and changes to payer rules: You’re busy providing patient care and managing other aspects of your medical practice – do you have time to stay on top of impending changes to payer rules, too? Reputable billing services are likely to be better informed about technical, regulatory, and marketplace changes on the horizon.
  • Analytics: A medical billing company may be able to identify ways to improve your billing processes, helping you avoid errors – and the resulting delays in receiving reimbursements.
  • Control: Your decision may come down to personal preference. Some physicians want to keep billing in-house because they like to have complete control over process and keep an eye on day-to-day business. Others would rather focus on patient care and leave the billing and collections to someone else.

What to Look for in a Medical Billing Company

Money_cog_cyleIf you’ve decided to outsource billing, take the time to evaluate prospective companies thoroughly, rather than choosing the lowest-cost provider. This will save you headaches in the long run. Although the company you choose will be handling the work, you’re still responsible for ensuring compliance and protecting your practice from liability.

Like medical practices, billing companies are subject to strict HIPAA rules concerning privacy, security and confidentiality breaches. When interviewing billing companies, here are some of the questions you should ask:

  • What services do you offer, and how much do they cost?
  • Do you have or carry omission and errors insurance?  If they do not or ask you whats that RUN!!
  • Can I review your performance metrics, such as the percentage of clean claims on the first submission?
  • Can I purchase certain services and not others?
  • What do you offer in terms of customer support?
  • Will I need to upgrade my computer system in order to work with your company?
  • Can I read your business associate agreement (BAA) to see your privacy policy, security policy, and how you handle breach notifications?
  • How is information stored, and how do you protect confidential personal health information?
  • Who has access to confidential information and why?
  • Will messaging between my medical practical and your company be encrypted and secure?
  • Can your company legally bill Medicare?
  • Is your team trained in HIPAA requirements, and do they receive ongoing coding training?
  • How do you stay current when it comes to federal regulations and coding rules? Are you prepared for ICD-10 coding?
  • What is your process for handling claims and submissions?
  • Do you store records and documentation about my practice’s claims?
  • How does your company handle denied, unpaid, and partially paid claims?
  • How do you handle adjustments and refunds?
  • Can I see your procedures in writing, as well as sample reports?
  • Can I look at and audit my practice’s claims information when i want to?
  • Does your company have errors and omissions insurance in the event of misconduct?
  • Do you have liability insurance in the event of security breach?
  • If I cancel my contract with you, how will you return or destroy confidential information?
  • Can you provide testimonials and references from you other clients?

Outsourcing as Part of your Financial Strategy

Outsourcing RCM has the potential to lower the costs of running your medical practice and improve the efficiency of receiving payments. However, as you money_bagcan see, physicians must do their due diligence when selecting a vendor and continue to oversee all aspects of financial management.

Capson Physicians Insurance Company supports cost-conscious independent physicians and small group practices by offering lower-priced medical malpractice insurance, another important way to reduce costs. We hope this information about outsourcing billing will help you choose the best course for your practice.

Do you have questions about outsourcing your medical billing?  Call us today (888) 517-4992  Or email info@hpcbilling.com