Practice Notes

Exploring the Ins and Outs of Outsourcing the Billing Function

Physician practices wrestle frequently with the decision about whether to outsource their billing processes. It can be hard to balance the pros and cons. What’s good for one practice might not work for another.

So, whether you want to improve the billing practices within your practice or are looking for a vendor who can raise the output of your revenue cycle management, the answers to certain questions can lead to a better decision about outsourcing those functions.

Key questions

How does your practice billing and collection metrics compare with industry standards? Do you believe your billing and collection procedures and systems would benefit from upgrades? Have you accepted the need for more investment in your revenue cycle technology but lack the necessary capital? Do you know where to allocate your limited resources to maximize net revenue? Are your billing and collection operations keeping up with the practice’s growth?

Reimbursement models and payer requirements are evolving constantly. So be sure your revenue cycle processes and technology are up to the challenge. For example, is your practice able to keep up with changing compliance and payer policies? Have you had difficulty recruiting and retaining qualified billing and collections staff? Do staff members spend too much time trying to resolve denied claims? And last, do you have any concerns about misappropriation of funds or fraudulent billing?

If the answers to many of these questions are affirmative, consider subcontracting billing and collection functions to an outside vendor.

Third-party billing

This function should offer several flexible, value-based contracting options in which payments are tied to the practice revenue results achieved. In addition, the services it offers should be tailored to the practice’s structure and requirements. Solutions in the vendor’s package should function seamlessly with each other across the practice’s revenue cycle.

Look for a vendor that employs a full staff with experience in all phases of revenue cycle management, as well as the related technology. Its services should comply with HIPAA and support both ICD-10 and Meaningful Use in all stages. The vendor’s operations should include the ability to electronically process the submission of claims and remittances, and the use of credit cards. As an added feature, the arrangement should allow the practice access to all its billing data, up-to-date reporting and analytics competencies. Finally, through the outsourcing contract, the vendor should assume responsibility for resolving claims denials.

It’s worth the effort

Finding a billing vendor that meets these criteria will be worth the effort when it pays off in reduced costs and improved revenue cycle performance.

© 2015

This material is generic in nature. Before relying on the material in any important matter, users should note date of publication and carefully evaluate its accuracy, currency, completeness, and relevance for their purposes, and should obtain any appropriate professional advice relevant to their particular circumstances.