Outsourced Medical Billing – the prescription for new practices’ impressive ROI

Given the rapidly expanding patient base, and an insatiable demand for quality medical care, it is not surprising that each passing-by moment is witness to the birth of a new practice. Despite being driven by a larger healthcare vision, new practices – operating in a market-driven environment – are inevitably forced to lend equal significance to Rate of Return on Investment (ROI), which is the operational yard-stick for sustenance and growth in a highly competitive medical service market.

If pooling in the requisite resources to launch your medical services is one huge task, operating it on profitable basis is altogether a different proposition. Having ventured into a socially-responsible service, most of your time and resources will be expended on employing the best of physicians, diagnostic and curative measures, support and administrative staff, and facilities – all of which have direct impact on quality medical care, patient satisfaction, patient retention, and credibility that would further expand your patient referrals.

Assuming that you go on, and eventually achieve the objective you set out for – medical service credibility – would there be any guarantee that you would have achieved an equally credible and sustainable Rate of Return on Investment (ROI)? Medical bill realization, which is a matter of insurance coverage, would weigh heavily on venture practices, who are generally novice to stringent billing regimen governed by CMS. Further, a full-fledged in-house medical billing team may not be advisable as it, being slow to yield results, is equally capital-intensive requiring heavy investment on: Installation of Billing and Coding Platforms, and Training the staff on best practices in medical billing.

Amidst the prevalence of such uncertainty on in-house medical billing results, it is prudent to source your medical billing needs from a competent outside agency;

• Application of Advanced Technology Interface comprising use of latest medical billing softwares such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc.,
• Use of latest coding softwares such as EncoderPro, FLashcode and CodeLink
• Application of standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting
• Successful track-record of processing medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well

Beyond the above requirements, the Medical Billing agency must also provide comprehensive medical billing complete with:

• Patient Enrollment
• Insurance Enrollment
• Scheduling
• Insurance Verification
• Insurance Authorizations
• Charge Entry
• Coding
• Billing and Reconciling Of Accounts
• Denial Management & Appeals, and
• Physician Credentialing

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billers in U.S. for over a decade, and whose medical billing service – complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, account receivables, and compliance standards – can be an ideal solution for new practices that require phased implementation of medical billing process before considering in-house medical billing themselves.

Going by the recent statistics – 30 to 40% reduction in medical billing costs – our comprehensive billing solution is the prescription for new practices that seek an impressive ROI through simplification of revenue cycle, appreciable increase in collection rates, more patient inflow and referrals, and increased avenue for medical research and development.

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Assess the capability of your workforce: Is your clinic administration in the right hands?

The capability of your workforce as a physician is directly impacted by the number of people you hire and the efficiency of the staff. Ideally every business entity needs to find the right balance between the number of people employed and the profits or revenue that they help generate. This factor along with the efficiency of your staff directly affects your revenue and accuracy. Physicians in the United States face numerous challenges when it comes to choosing the right administrative staff because of the ever changing face of the health industry. Therefore it becomes important to analyze whether the administrative aspect of your practice is in the right hands.

The clinical staff cannot completely focus on your patients and handle the negotiations with insurance company all at the same time. Even if this is possible, it may drive down the profits due to errors from work overload. The best solution for this problem is to hire extra staff or medical billers and coders who are experienced in this field. Even though this may increase your investment in staffing, it will also increase your revenue, justifying the addition of such experienced medical billers and coders.

The three most important professionals that affect your productivity are the assistants, the receptionist and the support staff for billing and coding who can also negotiate and interact with payers. The most crucial role played in the administrative and revenue cycle management is that of medical billers and coders. It is important to hire medical coders and billers who are excellent in technical skills, have updated knowledge of HIPAA guidelines, and have experience in handling negotiations with payers. The technical skills required in medical billing and coding is not just about having good computer literacy but is also about numerous other qualities such as good communication skills and knowledge of recent trends in reimbursement in your specialty.

There are numerous other ways of enhancing your staff’s productivity and these may be as practical as optimal utilization of office space to something as intangible as motivating your workers. Some simple ways of enhancing or gauging the efficiency of the staff is measuring individual productivity, revising methods to modify or channel employee behavior and talent in the right direction, setting clear goals that are achievable, rewarding the staff whenever required, and keeping a follow-up by evaluating whether the changes made are having a positive financial impact on your practice.

The reforms in the health care IT sector have also affected physicians dramatically, and utilizing latest technology such as EHR (Electronic Health Records), using practice management software efficiently and other IT tools has become necessary.

EMR system support and training are also important when deciding whom to hire to run the EMR system. Without an effective EMR installation, your practice may not be entirely proficient. EMR systems can profit medical facilities in numerous ways; the reports driven from an EMR can highlight the lacunae in a physician’s system and staff productivity. EMRs with facilities to audit logs, assigning tasks to specific staff member and regular follow up and reminders on pending tasks, provide tools to streamline systems. This means that EMR not only improve patient care but also assist in increasing the revenue in the long run. Efficient use of EMR or EHR is one of the most important aspects of the administrative side of a physician’s practice.

Assessing the productivity and capability of your administrative staff is a job that entails not just number crunching but also the level of patient satisfaction, the amount of time saved due to professionalism, the accuracy of medical billers and coders, HIPAA compliance, and meaningful use of the technology that is adopted for billing and coding. If all these aspects do not result in improved revenue over a period of time then it would be better to look for staff and medical billers and coders who can do the job efficiently and in a timely manner.

For more information about improving the productivity and appraisal of administrative tasks, please visit medicalbillersandcoders.com.

Boston Medical Billing, San Jose Medical Billing, Phoenix Medical Billing, LasVegas Medical Billing


About Medicalbillersandcoders.com


Medicalbillersandcoders.com is the largest ‘Consortium of Medical Billers and Coders,’ across the US. The portal brings together hundreds of billers, with experience in different specialties, on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US (Iowa Medical Billing, New York Medical Billing, Ohio Medical Billing, Texas Medical Billing), with the most prominent being Cardiology Medical Billing, Mental Health Medical Billing, Dental Billing, Oncology Medical Billing, and General Practice.