Medical-billing

At Svast, We get a lot of questions about Medical Billing outsourcing. So, we decided to answer them.

What is Medical Billing?

Medical billing is a complex process that involves submitting claims to insurance companies, managing claim denials, posting payments, and reviewing credits. Skilled oversight of the claim’s life cycle is critical for providers as it directly impacts revenue. This process requires multiple skills including Medical Coding, knowledge of EHR and practice management systems, and a very well-defined revenue cycle management workflow.

Is Medical Billing Outsourcing good?

Based on data available from our own experiences, and multiple industry sources, medical billing outsourcing has high ROI particularly for physician groups of less than 8 providers. End-to-end revenue cycle management is a complex process that includes eligibility verification, prior authorizations, medical coding, charge entry, charge audits, and RCM analytics. It is almost impossible for individual (in-house) medical billers to be able to define and execute on an efficient end-to-end process.

What is the ROI from Medical Billing Outsourcing?

In most cases a good Medical Billing company can generate 3% to 15% additional revenue. Our own data from the last 30+ years of being in business shows a sustained improvement of 15% in revenue. That is substantial! Outsourcing your revenue cycle management costs anywhere from 3% to 5% based on the size, specialty, and degree of outsourcing. So, if we take these 2 data points into consideration, the increase in revenue due to outsourcing more than offsets the cost. Providers not only save on the cost of hiring an internal medical biller, but they also generate more revenue.

Do Medical Billing companies also do Medical Coding?

Not all medical billing companies have the expertise to do medical coding. It is common for CMS to introduce code and regulation changes on a regular basis. Accurate Coding and modifier usage has a direct impact on revenue. Our data shows that 80% of our clients were consistently missing certain modifiers prior to us taking over. Correct medical coding is also critical from a compliance standpoint. So, it is very important to ask your revenue cycle management partner if they have certified coders on staff.

What are the risks of outsourcing medical billing?

The key risk from outsourcing comes when practices do not perform due diligence in identifying the right medical billing company for them. If the selected partner is good, the risk with outsourcing is low.

How to choose the right medical billing partner?

Assess 5 key aspects before finalizing your medical billing partner.

1.Understand in detail the medical billing partner’s vision and breadth of services. The ones who can provide end-to-end services including Eligibility, Pre-authorization, Coding, Charge Capture, Medical Coding – should be preferred.
2. Understand the potential partners capabilities in your specialty and the practice management system you use.
3. Understand the partners onboarding process. This will help you assess the PM system capability and process maturity of the team.
4. Review examples of the reports and analytics they would be providing monthly.
5. Speak to a reference – another practice that is using the services of the medical billing provider.