9 Signs It's Time to Outsource Your Medical Billing and Coding
Should a practice outsource their billing and coding or manage it in-house? This is one of the most important business decisions for practices to get right. Which is the better option for your practice? Here are nine signs that it may be more financially beneficial to outsource medical billing.
1. Do You Lack Visibility Into Billing and Payment Metrics?
Do you know your key financial metrics and how to improve them? Many practices are not aware of their actual revenue metrics which are the “vitals” for the financial health of their practice. For example, only about 35% of practices appeal denied claims, which means most are losing out on thousands of dollars every month.
Without the ability to measure these financial vitals, it’s difficult to know how to improve. Does your practice have a financial analyst as well as the staff with the skills to identify problems and make improvements? If not, practices should consider looking at external experts to provide these metrics and are able to make the necessary billing improvements.
2. Is Your Revenue Decreasing?
For practices that are aware of their billing and payment metrics, are you seeing your collections decrease? Is the time it takes to collect increasing? Unfortunately, this is more and more common among practices due to the ever-changing complexity of the insurance billing processes. Outsourcing is not the only solution, however fixing this problem internally can often be costlier and time consuming than outsourcing.
You need a solid income stream to keep your clinic operating effectively. If billing mistakes, coding complexities, and reduced reimbursements or denials have negatively affected your collections, then you need to consider outsourcing your billings and collections to keep your company from falling victim to a bad revenue stream.
Not only does this keep your business running optimally, it also allows your personnel to focus on other responsibilities and ensure quality customer service.
Is it time to outsource your medical billing?
3. Are Billing Errors and Rejected Claims Costing You Money?
The American Academy of Family Physicians reports that a 5-10% denial rate is the industry average. To be financially sound, practices should do what’s necessary to keep this rate below 5%. Because high claim denial rates require additional costs and staff time to correct and resubmit, many practices have found the outsourcing resolves this issue and provides higher net income overall.
4. Are You at Risk of Staff Absence or Turnover?
While every industry faces the challenges of staff turnover, the effects are often felt acutely among medical practices when billers leave. Since claim processing is integral to the lifeblood of a practice, replacements or new additions to your billing department unavoidably result in a slowdown in claims processing. Practices can remove this variability and risk through outsourcing their billing and pushing the staffing burden to the third-party. Practices then rely on a team that that can ensure the work of claim processing continues without interruption.
5. Are Staff Billing and Coding Skills and Training Insufficient?
Many practices take on the responsibility of hiring, managing and training Internal billing and coding staff. This works well in many practices. However, if billing and coding staff is under-experienced or not current on compliance and regulatory issues, practices must cost-effectively provide regular training to get and keep them current. Practices that prefer not to take on these burdens can find a simple solution in outsourcing.
6. Has In-house Billing Become Too Expensive?
Considering the costs of hiring, salary, benefits and administrative costs of in-house medical billers, practices may find it costs less overall to outsource their billing.
In additions to employee costs, practices must purchase equipment, software, and more. In-house billing costs can quickly add up. Practices should compare internal costs compared to the outsourcing to determine both the best operational and cost-effective method for billing and coding management.
7. Do You Have New Providers or a New Practice?
Newer practices may find it difficult to navigate the complexities of medical billing and coding. These new practices, or practices with new providers need to ensure they are focused on growing their business and providing a high-level of care.
Delegating important responsibilities to a trusted third-party allows new practices and providers to do just that. Outsourcing your medical billing during this time can relieve the burdens of hiring, training or managing a team of new billing employees.
8. Is Your Clinic Growing?
A growing practice can have similar challenges as a new clinic. Reputation is critical when growing your business, and ensuring high-quality patient attention and care can become more difficult.
As your staff will likely be tasked with more responsibilities and duties during this growth period, why not ensure they can still provide meaningful services by taking some of those administrative duties off their hands. Your personnel will thank you for this by continuing to provide quality care to patients, which in turn will help you to continue growing.
9 Is Your Attention Divided Between Patients and Running a Business?
Overseeing internal billing and coding requires a substantial amount of effort, time, and expertise. Without dedicated staff to handle this, the responsibility can fall on the shoulders of clinic owners, physicians, or other administrative staff.
This can mean less time focusing on patients or other relationship and practice management responsibilities. When practices outsource the billing process, physicians and administrators are free to focus on providing quality healthcare services to patients.
If you found yourself nodding your head to one or more of these questions, it's worth taking some time to learn if outsourcing would be better for your practice. NexTrust offers both patient and insurance billing services that not only improve revenue for our customers but allow providers and staff to focus on providing the highest level of care.
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Call NexTrust today 435-940-9123 or email us at to learn how our Patient Billing and Insurance Billing services can improve the financial health of your practice