Physicians facing uncertainty about changes taking shape in the healthcare industry should consider outsourcing their medical billing functions.

"Healthcare reform, Medicare fee schedule delays, staffing issues, computer problems, compliance issues … the list can go on and on," said R. Todd Warren, executive director of Medical Practice Solutions in Jackson. "Medical school, residency, and/or a fellowship program didn't adequately prepare physicians for what they face on a daily basis. Patients represent the lifeline of a medical practice. However, if you don't collect insurance and self-pay monies, it really doesn't matter how strong that lifeline appears. You have to collect the money in order to operate your business." 

Many solo practitioners and smaller group practice physicians are now realizing the labyrinth of moving parts involved in successfully operating a profitable medical practice. Outsourcing the billing functions of a practice now makes sense for a healthier bottom line.  

Warren pointed to primary factors contributing to this trend: 

• Human Resources. "Outsourcing your billing functions frees you from dealing with staff, staff turnover, training or retraining, or managing the many personnel issues that always seem to take time away from patient care," he said. "Also, strong billing companies have specialized staff, including Certified Coders, who can positively impact your billing success."
• Operations. "Strong billing companies file claims electronically, as well as receive remits electronically, which takes advantage of technological efficiencies," he explained. "They also implement coordinated follow-up techniques and routine processes for working appeals, rejections, and denials. These processes lead to faster turnaround time for your money. In addition, many billing companies function under a compliance plan, which is important as it protects the physician … since the billing company is an extension of your practice. Even further, most billing companies will conduct annual audits to ensure your coding is accurate." 
• Finance. "Many physicians seek the expertise of an outside billing company for one simple reason: the money is just not coming in," he noted. 

Higher collections, better control, and reduced management worries and expense are other reasons why outsourcing has become popular.

"Accurate medical billing requires more than simply submitting claims," he said. "Without data analysis and management of the billing process, recurring problems go unnoticed, claim problems are not identified for 45 days or more, and then are often too delayed to fix, and changing carrier rules and regulations are missed, resulting in seemingly inexplicable denials. Most practices have at least one story about the time their claims went unpaid—or unsubmitted—for a month at a time. Avoid all of these issues by imposing professional management on your billing process."

Even though many practices have a sense that in-house billing provides greater control over the billing process, Warren disagreed.

"An in-house biller can typically produce an accounts receivable report–and that's it," he explained. "An A/R report only tells part of the story. We can provide you with the information that's critical to effective management of your practice, including projected cash flow, expected recovery based on amount charged, detail on the status of every patient, claim and charge, and practice management metrics such as patients per day, collections per patient, and procedure utilization."

Warren pointed out that managing in-house billing staff takes time away from a busy practice.

"Every time a crucial staff person is out of the office, the billing grinds to a halt," he said. "Even worse, if a staff person leaves, you face new training expenses and delays that can significantly impact your practice. But once you outsource your billing, these issues disappear … they become our concern. And instead of struggling with day-to-day personnel issues, you can focus on the bigger issues that impact your practice."

When physicians find the right fit for medical billing outsourcing, the results "can be quite eye-catching," said Warren. "With no staff interruptions, staff expertise, and seamless processes, you can expect higher collections, better control of your finances, and fewer management worries. This all leads to a healthier bottom line."

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