If you opt to have your staff handle the billing, you're responsible for coding, submitting, and following up on claims. You'll need a certified medical coder on staff as well as an established process that ensures claims are created, scrubbed, and submitted in a timely fashion. If a claim languishes or is rejected by the payer, you need staff to manage that too. It's also crucial to stay on top of the ever-changing regulatory framework and new policies.
Keeping billing in house is often cheaper and you have more control over the process, but for a small practice with staff members who already wear many hats, billing can be time-consuming and complex. Worse, if the proper time and attention are not given to claims, you could lose a substantial amount of money.
Medical billing services alleviate that burden and wholly manage your revenue cycle for a percentage of your collections or a subscription fee, but it might be more expensive than in-house staff. A good medical billing service increases your collection rate, reduces rejections and denials, and even provides an analysis of your accounts receivable while freeing up your staff's time to focus on other tasks. You'll typically be able to generate on-demand reports and view your day-to-day finances through the company's software as well.
Whether you choose in-house billing or outsourced RCM, you'll need practice management software. If you outsource your billing, discuss with your billing partner the software they are familiar with. You'll also need to ensure that software is compatible with your EMR system.
Why Should a Large Medical Practice Hire a Medical Billing Service?
Large practices might hire a medical billing service for many of the same reasons a small practice would: to reduce overhead associated with maintaining full-time staff who follow up on unpaid claims and who manage rejections or denials. Large practices have more resources at their disposal than small practices, meaning they can usually retain some staff in-house, like coders, while outsourcing a portion of their medical billing process.
Our best pick for a medical billing service for large practices is AdvancedMD, though it does not perform coding services. While that deficiency may not work for a small practice, large practices typically perform coding in house, and then outsource the remainder of their billing service to AdvancedMD, for example. Outsourcing still removes the burden of managing claims from a large practice, allowing them to focus on rendering services in the here and now rather than chasing claims down from a month or two prior.
Why Should a Small Medical Practice Hire a Medical Billing Service?
Small practices use a medical billing service to cut costs and improve efficiencies. Additionally, many medical billing services also offer ambulatory EMR systems and practice management software, which small practices need to run day-to-day administrative and clinical operations. For a small practice, especially new practices just opening their doors, accessing a complete healthcare IT suite, in addition to medical billing services – usually just for the percentage cost of the billing service – is a big win. Some of the best billing services, like CareCloud, our best pick for flexibility, use a consultative approach that can help small businesses ramp up operations and grow their business.
Additionally, the best medical billing services ensure HIPAA compliance, protecting sensitive patient data, as well as your practice's financial information. HIPAA stipulates strict protections of patient data in transit and at rest, so your medical billing service provider must guarantee the requisite levels of security required under the law.
Outsourcing revenue cycle management can result in more money for your practice without allocating your staff to complete the arduous tasks of coding and billing. But how do you know which billing service to trust?
Key takeaway: Outsourcing RCM to a medical billing service makes sense when your in-house billing is too costly or is underperforming.