Medical Billing: In-House Issues; Outsourced Solutions

Installing a cost-effective, effectual medical billing team is one of the biggest challenges for any healthcare provider. Whether you’re a behavioral health provider, genetic testing lab or an opioid treatment facility, it isn’t easy to create, maintain and scale your own internal medical billing team. Below, some of the more common issues that most healthcare providers face and solutions.

Common Issues and Solutions

• Finding the Right Credentialers and Billers
  • Issue: One of the biggest problems in setting up your own credentialing and billing team is having to find the correct resources for the job. Although highly dependent on a healthcare provider’s physical location, generally in this line of work it’s challenging to find quality resources, pay them what they are worth and retain them by keeping them happy.
  • Solution: Outsourcing your work to a credible medical credentialing and billing company takes the need out of the hiring process, which already saves you time and money. Plus, make employee turnover a competitor’s problem.
• Health Insurance Portability and Accountability Act (HIPAA) Compliant
  • Issue: There are many healthcare providers using a vast array of digital communication and clearinghouse tools that aren’t HIPAA complaint. E-mail platforms, chat tools, texting mechanisms, document storage applications, medical billing and credentialing software, etc. This is a huge issue, if you are audited and caught you can face serious penalties for failing to meet standards. Penalties can be financial and / or criminal.
  • Solution: Trustworthy medical billing and credentialing companies take HIPAA compliance as a matter of serious concern and this is always taken into consideration when making a decision on communication and clearinghouse applications. Because these types of tools are managing protected health information, it’s vital that they meet HIPAA regulations.
• Office Space Costs
  • Issue: If you plan on hiring your own team of medical billers, that will require space in your office and additional resources and that will cost you money.
  • Solution: By outsourcing your medical billing, billers simply do not need a physical work station and records are housed in a HIPAA compliant, outside, secure location.
• Using the Wrong Medical Billing Software
  • Issue: Using cheap, buggy and poorly supported (or all three) software will get you nowhere. This is a huge problem for many healthcare providers. A lot of providers get talked into using software that doesn’t get the job done correctly. Although typically not the fault of the provider, the internal technical expertise just isn’t there. When a provider buys into a tool that doesn’t do what it claims, it causes internal headaches and strife. Long terms contracts with unproven software, should also be avoided.
  • Solution: Utilizing an experienced, 3rd party credentialing and billing service provider will benefit you greatly. They’ll have a deep understanding of the most powerful and popular medical billing software applications and which ones will work for the size of your practice and volume. Their proficiency will only enable you to get paid faster. Always remember, outsourced medical billing companies don’t get paid unless you get paid. That’s how it works.
• Lack of In-depth Marketplace Knowledge
  • Issue: In-house billers will never know what their competition (same provider types) are up to and they’ll always be guessing on their end results. Additionally, in-house billers don’t have as wide of a scope as outsourced billers do, as generally they work in one specific provider type.
  • Solution: Access a broader perspective of what’s going on in the healthcare marketplace. This is one of the most valuable intangibles.
• Reduce Incoming Phone Calls and E-mails
  • Issue: This might not sound like such a big deal, but the amount of wasted time an office incurs due to unwanted and unwarranted calls and E-mails can be astronomical. Especially, when it comes to having to deal with denied claims.
  • Solution: Relieve your internal staff of unwanted and unwarranted calls and E-mails, by sending those directly to your billing company. Billing and claims errors will be heavily avoided, when calls are being made by an credible medical billing group on your behalf. You’ll not have to deal with any of that.