Speeding Payment Through Strategic, Outsourced Billing

While this can work for some organizations, there are several drawbacks to managing billing internally:

• Costly overhead expenses – In-house billing requires investment in staff, software, infrastructure, and ongoing training. This represents a major cost center that cuts into the bottom line.
• Limited expertise – Billing staff may not have specialized experience or expertise in claims management and denial prevention. This can lead to mistakes and compliance issues.
• No economies of scale – An in-house team handles billing for one organization, limiting the ability to leverage technology and best practices.
• Administrative burden – Billing and claims management is hugely time consuming and detracts from patient care. It also requires constant staff oversight.

These challenges of in-house billing lead to denied claims, payment delays, and reduced revenue. The right outsourcing solution can help address these issues.

The benefits include:

• Faster payments – Outsourcers are efficient in submitting error-free claims quickly and have resources to relentlessly follow up on unpaid or denied claims. This expedites payment turnaround.
• Lower denial rates – Leveraging economies of scale and specialized staff reduces claim errors. Fewer denials means faster payments.
• Reduced administrative work – Outsourcers handle the entire billing process, freeing up staff resources and allowing providers to focus on patient care.
• Access to advanced technology – Outsourcers utilize specialized software and workflows not economically feasible for an in-house team. This optimizes the billing process.
• Increased revenue – Enhanced collections and fewer missed billing opportunities increases reimbursement rates and bolsters the bottom line.
• Scalability – Outsourcers can easily add staff and resources to meet changes in client workload. In-house teams lack this flexibility.
• Improved compliance – Outsourced billing experts stay current on changing regulations and payer requirements to avoid penalties.

The combination of these benefits allows outsourced billing to improve cash flow by getting claims paid accurately and efficiently.

When researching and assessing potential outsourced billing firms, providers should look for these key capabilities:

• Specialized industry experience – Choose a firm with expertise in medical billing vs. general accounting outsourcers. Deep healthcare experience translates to better performance.
• Understanding of latest regulations – An outsourcer well-versed in changing healthcare rules and payer nuances will achieve better claims outcomes.
• Technical capabilities – The outsourcer should utilize advanced clearinghouse integration, practice management software, predictive analytics, and automation to optimize processes.
• Reporting and analytics – Robust reporting and dashboards allow transparency into performance and visibility into areas needing improvement.
• Scalability – The firm should be able to easily ramp up staff and resources to match changing business needs. Lack of capacity can lead to billing backlogs.
• Client focus – A client-centric company will work hard to understand the provider’s specific needs and adapt processes accordingly.
• Security – Strict data security and HIPAA compliance practices are a must when handling protected health information.
• Results – Providers should review customer testimonials and success metrics to validate the outsourcer’s ability to achieve outcomes.

By thoroughly vetting potential partners against these criteria, providers can select an outsourcing firm positioned for success.

Once an outsourced billing partner is selected, there are best practices providers should follow to ensure a smooth implementation and effective ongoing management:

• Clearly define expectations – Both parties need to agree on scope of services, performance metrics, communication protocols, and reporting needs upfront to prevent future issues.
• Start slow – Begin by outsourcing a subset of billing functions vs. the entire process. This allows assessing capabilities before full transition.
• Maintain visibility – Review reports and dashboards to stay apprised of performance, identify problems early, and collaborate on solutions.
• Share insights – Provide insights into patient base, common payer issues, past claim challenges, and other nuances to improve outsourcer effectiveness.
• Designate liaisons – Have point people from each organization serve as the main contacts for sharing information and resolving concerns quickly.
• Monitor closely at first – Oversight is critical early in the partnership while processes are optimized. Close collaboration is key.
• Plan for volatility – Workloads, regulations, and client needs inevitably change. Maintain plans to scale resources appropriately.
• Review periodically – Set regular meetings to review performance metrics, address problems, discuss improvements, and align on next steps.
• Share feedback – Provide regular input on what’s working well and areas needing improvement to help the outsourcer optimize processes.

By investing time in implementation planning, maintaining visibility, and collaborating closely with their outsourcing partner, providers can maximize the likelihood of achieving desired outcomes.

Here are best practices for narrowing down the multitude of outsourcing options:

• Define your needs – Document the current billing workflow, problem areas, revenue goals and other requirements so prospective partners understand objectives.
• Leverage industry resources – Trade organizations like the MGMA provide directories of vetted medical billing firms to begin your search.
• Seek referrals – Other practices in your specialty likely have experiences to share. Local colleagues are a trusted source.
• Research options – Search online and create a list of potential partners. Look for consistently positive reviews.
• Interview prospects – Have in-depth discussions to gauge qualifications, experience, technical abilities, and company stability.
• Request proposals – Ask a few top contenders to outline their approach, services, and pricing so offers can be compared.
• Check references – Speak to current clients evaluate services, responsiveness, and results achieved.
• Compare strengths – Create a matrix comparing partners across crucial criteria to make an informed selection.
• Prioritize alignment – Ensure chosen partner prioritizes your needs and has a proven track record with organizations like yours.
• Start with a pilot – Implement billing outsourcing slowly to prove capabilities before full transition.
  

Here are best practices for managing your outsourcing partner:

• Maintain open communication – Discuss challenges promptly, brainstorm innovations together, and keep the lines of dialogue open.
• Provide ongoing feedback – Share what’s working well and where improvements could be made to help optimize processes.
• Review metrics consistently – Regularly analyze denial rates, aging claims, revenue cycle efficiency and other metrics to catch issues early.
• Monitor patient satisfaction – Receiving complaints about incorrect billing is a red flag warranting investigation.
• Discuss process refinements – As needs change, work together to adjust workflows, resources and technology.
• Share insights proactively – Inform your partner of upcoming operational changes that may impact billing.
• Periodically re-evaluate – On a set schedule, thoroughly reassess the relationship to ensure it is still the best fit.
• Maintain flexibility – Be open adjusting the relationship as market dynamics evolve.

By taking this vigilant, collaborative approach, providers and their outsourcing partner can build a relationship poised for long-term success.