Medical Billing and Coding: In-House Vs Outsourced

Efficient medical billing practices are central to proper revenue management. When setting up a new health care practice, healthcare professionals are faced many administrative issues. One important question is whether they should outsource their medical billing services to a medical billing company or set up the infrastructure to do it in-house. In-house medical may seem like a good idea if you think it can help you keep track of what’s going on quite easily. However, there are many practical issues involved, as explained below.

In-house Medical Billing – Requirements and Issues Involved

Carrying out in-house billing and coding would require you to invest in the complete set-up for these task. This would mean:

  • Allotting space in your practice to a billing section
  • Hiring a team of medical billing specialists. They would need to be well-versed in current billing and coding practices
  • Investing in equipment, software and reference material
  • Registering with a clearing house

Supporters of in-house billing argue that it gives the practice more control over financial operations. Financial reports are readily available whenever needed. Issues can be dealt with as and when they occur and appropriate action can be taken.

But there’s the flip side. Setting aside additional space for billing is not easy, especially in a small- or medium-sized practice. Your expenses would include the salaries and employee benefits for the billing team as well as the cost of the equipment and technology needed to perform the task. You would also have to deal with software upgrades and occasional technical issues. Besides, if a key employee in your in-house billing team decides to quit, you may be left with a lot of unfinished tasks. Turning your attention to billing issues would mean less time for patient care. This would seriously affect your bottom line.

Outsourcing Medical Billing – A Feasible Option

Medical practitioners are discovering that hiring the services of an established and reliable medical billing company is a much better alternative to in-house handling of these specialized tasks. Outsourcing billing and coding services to billing companies can take much of the burden associated with the billing process off your shoulders.

  • The provider is well-equipped with advanced billing software and hardware including support services. They can even work with your own medical billing software.
  • You save on hiring a team of experts. The outsourcing company has a certified billing and AAPC certified coding professionals to handle your process. Coding is performed efficiently, which minimizes rejected claims. The billing specialists verify all demographic details, and insurance eligibility and benefits to ensure accurate claim submission for maximum reimbursement. They also follow up with insurers on rejected claims.
  • Stringent QA measures ensure high levels of accuracy.
  • Timely and customized reports keep you informed of progress.
  • With a HIPAA compliant billing company, all standard security norms are adhered to when handling all your documents.
  • The right company would provide your practice with a comprehensive suite of services even without a long-term contract.
  • Services come at affordable rates.

Outsourcing billing and coding also allows physicians to focus on their core tasks and provide better patient care. The right service provider can help them save up to 30-40% on their costs. It’s amply clear that outsourcing has a definite edge over in-house management of these important tasks.

Source :

Reasons Why You Should Use Medical Billing Services For Your Office

Outsourcing to medical billing services is a common practice among doctors these days, because it allows them to concentrate on practicing medicine rather than bill collecting. There are several ways that outsourcing helps doctors to do this, and the top four are presented below.

Insurance carriers and compliance and regulatory agencies are constantly changing and updating billing rules, which makes staying current with the latest billing requirements an immense task that requires a lot of staff member time, energy, and effort. Outside medical billing services can free up staff to perform other essential tasks that sometimes are put on the backburner, making sure they get the attention they deserve.

The constant changes in insurance laws and requirements make keeping in-house billing software updated a rather expensive endeavor. Medical billing services avoid the expense and headache of buying, updating, troubleshooting, and maintaining these software systems.

You will tend to have fewer claim rejections with an outsourced billing agency. This is because, in part, a billing agency has more incentive to collect your claim, since what they are paid is directly related to how much you get back on a claim. The same is not true of an in-house biller because they are paid the same, regardless of whether you have a high or low claim rejection rate. Also, the fact that they are dedicated solely to billing, and are not distracted by other tasks like many in-house billers, speeds up the claim process, and reduces the chance that they will have unbilled claims resulting from misplaced patient encounter slips.

Another aspect that many don’t immediately think of is in-house theft. There are thousands of dollars of unauthorized and fraudulent claims made each year by billing employees. Using outsourced medical billing services reduce this threat, creating a check and balance system that makes it easier to see where claim funds are coming and going, and make it easier to spot any financial inconsistencies that might surface.

In a nutshell, outsourcing will keep you updated on claim requirements, save you money on software and in-house billing employee wages, lower claim rejections, and significantly reduce the change of employee theft. This makes it worthwhile to consider the option, especially since there are a variety of medical billing companies to choose from out there. Research a few to see which one best suits your billing needs and requirements, and then all you devote your time to paying attention to what what’s important to you – your practice and patients.

Source :

Medical billing software-A Key Solution to All Your Billing Needs

The billing process in all sectors was manually and sometimes some unexpected errors might be happened. But now, you have got the facility of handling the service by the software. In hospitals or in the nursing homes a lot of patients come every day and they issues of them needs to take an updated version in this age of improved technology. This is the reason, you as a patient will get an improved service from any of the hospitals and at the same time the hospital authority will get relaxed from the burden of huge calculation manually. This is the physical point of view and if you consider about the issues related the billing and its fixed dates, the payment procedure, the bill that should be paid by the insurance company of the patient party, the uncollected bills from the patients and the fixed date of the bill to be paid should well be mentioned in the medical billing software.

Now, you will get a lot of companies with which you will get the different features of the using procedure of medical billing software but the basic criteria is the same. All the medical billing services are providing basically the same service related to keeping the calculations of the patients’ account. So, now those kinds of software will be preferable that are of the user friendly and simple enough in its use. Not only these features will get preference, the costs of the software are also one of the main factors of purchasing the software. The hospital authority will choose that kind of software that is lower of cost. So, easy to use and low cost medical billing software will be in use of all the medical department of hospitals.

The main thing that the medical billing software does is that to clear the billing and insurance clearance. If the patient has the claims of health in any of the insurance company, they bills and cost of the medical treatment will have to bear by the insurance company and at that point of time with the help of this software, you will get the sooner service of payment in time of treatment in the hospitals of nursing homes. This reduces the errors and rejection of application of the claim applications to the insurance company. Thus, this kind of medical billing software will work.

How Medical billing software fastens the process of preparing bill

Medical billing software is really very useful as it helps in preparing medical bill. Medical bill is the most important in the whole medical billing system. Medical billing system has been invented to help poor people. Those who are poor and are not able to continue their treatment in a proper way for them this billing software is really very useful which helps people in doing their treatment in a proper way. The bill contains all important details about patients. After the preparation of the bill is done, it is submitted to the insurance company. The insurance company first analyzes the bill and then makes the payment. If the company finds any kind of dispute in the bill, the company may deny making payment. So it is really very important that the bill should be prepared with accuracy.

Prior to the invention of medical billing software, the preparation of medical bill used to be a very tough task. It used to take lots of time and effort. But now this task has been made easier and medical bills can be prepared within a very short period of time and with accuracy. In medical bill, all important details about patients are mentioned like patient’s name, address, the name of the physician under whom the patient is doing his or her treatment, the name of the disease from which the patient is suffering from etc. all these are important details which should be mentioned in the bill. By submitting the bill to the insurance company, patients will get medical claim from the insurance company.

Various types of billing software have recently come in market. This software is used in preparing medical bill. It fastens the process of preparing bill. It has also lessened the burden of medical department. Today, in most of the hospitals and medical institutions this software is used in preparing bills. Among various types of billing software people mostly use two types of software. One is NueMD and another is Lytec. These are the two types of billing software which people mostly use in preparing bills.

For getting more information about this medical billing software, one can take the help of internet. There are many online sites are available through which one can get useful information and will also come to know how this billing software helps in preparing medical bills.

ICD-10 Codes: What Will Change About Medical Billing

As with any significant change in procedure, there is a portion of the medical billing and medical coding community that wants to panic. There are also many people who are in denial about how this change to the ICD-10 codes will affect them. To clarify some of the commonly misunderstood aspects of this change, below are the facts about medical coding changes due to ICD-10 implementation codes.

Compliance and Flexibility

The compliance date for switching to ICD-10 codes is October 1, 2013. There have been rumors circulating that that date is somewhat flexible or that extensions will be granted either to individual practices or to everyone. The compliance date is set and will not be changed. All health care providers must use ICD-10 codes by Oct 1, 2013.

Additionally, many people believe that compliance with ICD-10 codes requirements is only necessary if you are using electronic medical records and an EMR system. This is also an incorrect assumption. No matter whether you use electronic medical records or you are still doing all of your filing on paper, the ICD-10 codes will be required for all medical practices.

Too Many Numbers

Changing from a code system of about 13,600 codes in the ICD-9 to the ICD-10 codes which number over 144,000 sounds daunting. The exponential rise sounds overwhelming, and it should come as no surprise that medical coding professionals are worried that it will be too complex to be practical. There are also criticisms of the documentation, claiming this level of detail is unnecessary.

ICD-10 codes are structured to be more logical to use and the codes are more clinically accurate than the ICD-9 codes. Medical coding should be easier, not harder. The structure itself is improved so that you will be searching through categories which contain more specific codes than the previous version. Of course every change requires some learning and adjusting. But once medical coders settle into the new system, they may find they like it better than the previous system.

Introduction of Unnecessary Tests

One concern voiced by clinicians is that with a more complex and detailed set of ICD-10 codes, medically unnecessary tests will need to be taken with patients so that a diagnosis can be made and the correct code can be assigned. Fortunately, this is not the case. Nothing about the ICD-10 codes should dictate what medical tests and procedures are prescribed for your patients. The ICD-10 codes are for documentation of what is found by the clinician.

If a diagnosis hasn’t been made, the code used will be dictated by the symptoms. The ICD-10 codes are more flexible in this way than the ICD-9 codes, and they still contain the non-specific codes that can be used when you cannot make a diagnosis.

Many medical professionals are nervous about the change to ICD-10 codes. Before you worry about what this change will mean for you and your practice, remember that the ICD-10 codes were designed by and for people like you.

Source :

Medical Billing Outsourcing – Choosing an Appropriate Service Provider

Poorly managed medical billing can be quite damaging to medical practices. Assigning the correct medical codes, determining the patient’s eligibility, submitting claims duly to the payers and other related jobs are all processes that require consistent attention. Medical professionals usually outsource medical billing requirements to a medical billing company to keep track of insurance billing codes, rejected claims and uncollected revenue. Medical billing and coding processes have to be assigned to a professional medical billing company that has in-depth knowledge and excellent experience in offering end-to-end medical billing services.

Medical billing companies manage your entire billing process, track your accounts, submit claims to insurance companies and follow up on them so as to ensure you receive payments on time. They also provide services such as patient enrollment, insurance enrollment, charge entry, submission of claims, insurance eligibility verification, accounts receivables follow-up, payment posting, denial analysis, scheduling and rescheduling, accounts receivables management and report maintenance.

Guidelines to Choose a Suitable Service Provider

You must consider several aspects before you sign a medical billing outsourcing contract. Listed here are a few guidelines that can help you find an appropriate medical billing company for your health care facility:

  • Years of experience in the industry: Look for a provider with considerable medical billing service experience and a successful track record. Firms having many years experience and a reputable record in the field can deliver quality medical billing services. So prior to choosing a firm, it is necessary to check whether your service provider meets the requirements of your medical facility and ensures timely payment of claims.
  • Comprehensive medical billing solution: Before hiring a company, it is necessary to find out whether the company you choose offers a comprehensive billing package which includes insurance/patient enrollment, scheduling, insurance verification and AR collections. Apart from these, some companies provide other services such as credentialing and medical coding and transcription.
  • Efficient management of medical records: Some of the billing firms have their own software while some others use licensed software. Some provide both electronic and paper documentation of medical records. For the efficient management of records, billing firms use the latest software like NextGen, IDX, Medisoft, Inception, Lytec, Medic, Misys which would ensure accuracy. While hiring a firm, it is necessary to ensure that your records are professionally managed and you get periodic updates and reports as and when necessary.
  • Compliance with HIPAA standards: Your patient’s medical information is strictly confidential. While employing a medical billing and coding company to handle sensitive and confidential medical records, you should make sure that the firm you choose complies with HIPAA regulations and follows 128 bit encryption for all transferred files.

Other Things to Consider

  • Ensure that the practice management system provided by the company is useful and user-friendly.
  • Check whether there is a provision for easy access to information such as outstanding claims, charge data, user notes, follow-up information and payments.
  • Make sure that the terms and conditions on which the company works are flexible enough to make necessary changes as per client’s requirements.

Simply follow all the above mentioned points to ensure that the provider of medical billing services you choose is efficient enough to handle your medical billing process.

Source :

Five Tips to Improve Medical Billing

In this challenging economy, families still need medical care but may not have the means to pay for it when the bill comes due. This can prove challenging for medical billing agencies. In such a climate, medical billing services need to increase their effectiveness and efficiency in order to get the best results for their physician and medical facility clients. Consider these tips to improve medical billing practices:

1. Use technology as an advantage.

Medical billing services that strive for effectiveness and efficiency may find technology advantageous. By utilizing up-to-date software for medical billing, organizations have the opportunity to quickly determine whether claims are likely to be accepted or denied based on the ever-evolving changes in billing rules for insurance plans, Medicare and Medicaid. The highest quality software automatically updates as rules change, helping medical billing professionals determine new trends in denials and work toward increasing the amount they can collect for clients.

2. Develop and utilize a formal service contract.

Running a medical billing business is just that: a business. It is critical to have all parties involved – the medical facility or physician and the medical billing agency – sign a contract that delineates exactly which parties are responsible for each task, how payment will be made and terms for ending the contract. Having a billing contract emphasizes professionalism and helps protect the physicians and medical billing company.

3. Use business intelligence to identify areas for improvement.

Accurate data mining is one of the best ways for medical billing agencies to improve their level of service and collection. With the innovations in medical billing software, unique reports can be run that provide specific information to assist in decision making and implementing improvements. Most of today’s billing software does offer the option to create custom reports. Once reports have been completed, they can assist medical billing management with increasing staff productivity, adjusting staffing requirements, as well as quickly identifying payment errors.

4. Communicate wisely with patients.

Front Desk Patient Getting Medical Billing InformationMedical billing professionals can assist medical staff by encouraging the posting of all billing information in an obvious location in the patient check in area. By having the terms of payment easily visible for patients, there is no confusion about billing practices of the medical service. This information should include insurance requirements, upfront payments, co-payments and billing procedures.

5. Collect full information.

One of the best ways to help a medical billing agency increase efficiency is to make sure patient information is accurate and complete. Having a patient’s address, full name, birth date, work information and multiple phone numbers is a critical part of the data collection process that will be used both with insurance companies and as part of the collection process, should requests for payment be ignored. Additionally, asking patients for their Social Security number is an excellent practice that can be extremely helpful when cases of non-payment are turned over to a collection agency.

Clearly, there are many ways for a medical billing practice to become more efficient and effective. Acquiring accurate patient information, using a comprehensive contract with physicians and medical services as well as utilizing cutting-edge software are all steps to optimize the organization. Incorporate these steps today to see a medical billing agency grow more profitable.

EHR Could be Key to Better Revenue Cycle Management

Practices are feeling pressure to improve access to care while simultaneously driving down costs. This will become even more important as the Affordable Care Act (ACA) decision takes effect. Millions of Americans who were previously unable to seek the care they needed will now be able to see physicians.

At the same time, practices are being asked to adopt a new coding system – ICD-10 – in place of the outdated ICD-9, which the majority of providers are still using. They are also facing pressure to switch from paper-based documentation systems to electronic health records (EHRs). Since these changes are all falling into place at the same time, notes Becker’s Hospital Review, many practices are concerned about the investments they will need to make in order to stay on top of these changes, receive the incentives available and earn maximum reimbursements from Medicare and Medicaid.

Health IT tools solution, not problem

A recent article by Healthcare Finance News points out that while physicians may believe health IT tools are the problem, they are actually a way to improve their revenue cycle  management.

“Declining reimbursements and rising overhead costs, as usual, are to blame,” Steven Ferguson, patient management officer at Hello Health told Healthcare Finance News. “So what is a doctor in a small independent practice to do? One place to start looking for solutions is their in-practice technology stack  – starting with their EHR.”

Ferguson points out that physicians can use their EHRs to streamline a number of processes that might otherwise drain their time, and thus, financial resources. For instance, doctors can use their systems to manage referral processes, schedule and attend meetings with pharmaceutical representatives, meet meaningful use measures and send charts to health insurance companies, he adds.

Doctors overcoming revenue challenges with new tools

To overcome the challenges doctors face with multiple deadlines, a changing marketplace and declines in reimbursement rates, physicians across the healthcare industry might find they need to change their revenue management strategies, reports Becker’s Hospital Review.

“[Health systems] really need to put together a work plan that is going to start a deep dive in the revenue cycle process, from the front end to billing and claims management to dashboard reporting,” said Julie Corcoran, principal consultant at Hayes Management Consulting.

In fact, 53 percent of surveyed providers said an upgraded revenue cycle management system would become a priority to improve the efficiency of their facilities, according to the 2012 U.S. Revenue Cycle Management (RCM) Study by Capsite.

Latest improvement in medical billing outsourcing

Do you miss the good old days where you could treat the patient and get paid just like that minus the medical insurance claims hassles? Well folks, things have changed a lot for good or worse. The most modern medical billing system has created a lot of confusion and headache to the practitioners around the country. The evolution of the same has inflicted a state of panic around the medical industry. The present scenario is a little challenging, forcing the practitioners to work overnight clearing the billing and coding hassles. Here, I would like to stress the importance of medical billing outsourcing and the advantages offered by the same.

Medical billing outsourcing: reasons for outsourcing

Defining the limits of the billing system is not only complicated but literally impossible. Analyzing the patient demographics is one thing, coding the procedures is another chore. Not to mention, the charge entry process often drives us crazy. There are a bundle of procedures that need to be completed before the claim actually gets submitted. As such, any trivial mistake in anyone of the procedures will result in a total denial. Your only solution is medical billing outsourcing, which has made tremendous impact in the revenue management. The said method has numerous benefits and advantages. By medical billing outsourcing, I mean assigning your day to day office works to an external service provider so that they will finish the work before a period of time.

This will help you minimize the billing errors and help you achieve reimbursements faster. As such, the difficulty is reduced drastically. You can sit back, relax and treat your patients with ease while the medical billing companies work on their part. Medical billing outsourcing will eliminate the usual concerns of the physicians and make the practice stronger. If you just think about your previous experience with the manual data entry process, I am sure you will contract with a service provider right away. Such providers assist your staff in successfully completing the medical billing process. Medical billing outsourcing companies have state of the art technologies and experienced personals to asses, organize and double check the claim for errors. Apart from that, these companies deliver the result on time without delays.

Importance of Medical Billing and Coding for Physicians

The importance of Medical Billing Services cannot be overemphasized in an era where health reforms are changing the face of the health care industry in the United States. Medical billers and coders not only ensure the accuracy of the billed amount but also simplify the process of how physicians are reimbursed. The job of medical billers and coders is not limited to just medical billing and coding. They also perform many other necessary functions such as interacting with payers, managing the revenue of physicians through a systematic approach towards revenue cycle management, managing denied claims effectively, and ensuring patient privacy.

Accurate Medical Billing and Coding

The job of a medical biller and coder requires specialized and thorough training since errors can cost physicians heavily in terms of provider revenue and the way in which healthcare is delivered. Errors in medical billing and coding impact physicians negatively, in some cases the physician may be denied participation in any government affiliate program such as Medicare or Medicaid under the False Claims Act due to errors in medical billing and coding. The responsibility of ensuring accuracy and thus protecting the revenue of the physician lies with the medical biller and coder. The learning curve accompanying the health reforms is not just limited to physicians but is also encountered by their staff, including medical billers and coders.

Medical Billing and Coding Post-Reforms

The possibility of errors in the medical billing and coding industry has increased due to the migration from ICD-9 toICD-10 codes. The latter are more complicated and expansive compared to ICD-9 codes, thus increasing possibility of errors. With almost 19 percent of claims being denied due to errors by insurance companies, the handling of these ‘mistakenly’ denied claims falls upon medical billers and coders who have to extensively interact with the payers in order to correct these errors.

Revenue Cycle Management

Another important task of medical billing and coding companies is revenue cycle management. The revenue cycle management process entails functions such as clinical care documentation, charge capture, coding and utilization review, billing, collections and follow-up, denial management, and data warehousing and analytics. However, there are many other pre-visit tasks that are part of the revenue cycle management that is the responsibility of medical billing and coding companies. These tasks include administrative functions, patient scheduling, checking medical eligibility, benefits verification, registration, and point of service collections.

The role of medical billers and coders in assisting providers to receive timely and accurate reimbursements has definitely increased after the reforms. The need for better medical billing and coding is being felt since a solid platform in the form of better departmental processes is needed for the higher or core objectives of the reforms to work in favor of physicians.