Ebbing with the current healthcare industry can be challenging, especially if you are doing business in California. Even when you have talented and capable staff, changes in policy can make staying in compliance tricky and time-consuming.

Process of Outsourcing Medical Billing

Within the last 5 years or so, changes to state and federal law have expanded the roles of medical providers. This raises the question for many providers in the “Golden State”: Should I outsource my medical billing? To come to a decision, we need to talk about the process of outsourcing medical billing.

Patient Enrollment and Verification

Just getting a patient into care is a multifaceted process. Fortunately, it is just one of the many solutions that medical billing companies provide to you.

It begins with registration; getting the patient’s demographical information, and then verifying their insurance to determine the nature of their coverage. Once this has been done, the insurance company must sign-off or “authorize” the services before treatment can begin.

Medical Coding and Billing

Providing vital services to your patient is at the core of what a medical practice does. Medical billing & coding, on the other hand, is what is behind the scenes holding your operation together.

Medical coding is a complex numerical system for medical classification that utilizes international standards such as the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT). With it, providers can track their patient’s progress, log their medications, and itemize the services they receive. It is also used for billing patients and insurance.

Coding done right minimizes errors and maximizes efficiency; protecting both the patient’s health and their wallet while ensuring that providers are accurately paid for their services.

Outsourcing your billing and coding to a reputable billing company, can:

  • Reduce errors in coding
  • Prevent administrative slowdowns
  • Keep you compliant with state and federal law
  • Minimize claim errors and disputes

Auditing and Collections

Debt collection is an unfortunate part of the process. Not only does it draw things out, but it can be a major source of revenue loss.

Another source of revenue loss can come from errors in the claim process. Such mistakes can lead insurance companies to deny your claim or withhold payment. The reality is that you probably have better things to deal with, and by enlisting a medical billing company, you don’t have to.

Why Choose In-House Billing?

PROS

  • By maintaining a working proximity to medical coders, you gain the ability to communicate directly about any changes that need be made to a patient’s medical information and billing claim.
  • Providers that have already invested into the infrastructure of medical billing by purchasing software and training administrative staff want to see a return on that investment.
  • Some providers prefer the control that an in-house operation affords, unlike that of a billing company which has its own way of doing things.

CONS

  • Purchasing billing software and hiring coders and consulters can be expensive.
  • When you do your own coding and billing, you are liable for any mistakes that occur as a result.

Why Outsource Your Medical Billing

PROS

  • It allows providers to focus on what they are best at: providing quality care.
  • Medical coding companies offer coding, billing and consulting services at a cheaper price than hiring staff directly.
  • Billing companies are staffed with financial experts who know how to keep you compliant with state and federal laws.
  • Outsourcing your billing reduces the number of duties for administrative and medical staff helping your operation run more efficiently.
  • Billing companies regularly run audits which prevents claim errors and disputes from occurring.
  • Billing companies work tirelessly to recover lost revenue from billing claims, saving you money.
  • Outsourcing your billing prevents slowdowns due to turn overs, vacations, or absences.

CONS

Moving your billing off-site results in less direct knowledge about the medical billing process. It also means that if you have any questions about a claim, you may have to wait on the phone or schedule an appointment with a consultant to get an answer. This could additionally lead to frustration with patients who are trying to get information about their billing may not be directly available.

Challenges California Providers Face

Simply put, the biggest challenge California providers face is staying compliant.

California is in a unique situation because it has robust medical billing laws. As such, providers that do their own billing may have difficulty adapting to the changes and rolling with the punches of adhering to state and federal laws.

In 2016, then-governor Jerry Brown signed into law AB 72: a new bill that would protect consumers from surprise medical billing due to certain out-out-of-network costs.

Another bill designed to address balanced billing, The No Surprises Act, is slated to go into effect on January 1st,2022. For California providers, knowing when to defer to state or federal law is a concern when doing in-house billing.

Here are a few issues that California providers face when dealing with new billing regulations:

  • Training administrative staff to effectively deal with regulations
  • Providing price and service transparency for consumers
  • Determining reimbursement for out-of-network doctors (making sure they aren’t being under or overpaid)
  • Handling IRP disputes with out-of-network doctors that are seeking higher compensation for their services
  • Preventing patients from being overcharged for care, especially from balanced billing
  • Avoiding penalties due to billing mistakes
  • Streamlining rate negotiation with insurance companies for out-of-network ancillary care and avoiding claim rejection
  • Making sure billing is compliant and consistent

Statim LLC is a billing and coding in California. We are dedicated to serving medical providers in the state of California. To learn more about how our comprehensive approach to billing can save your business money while letting you focus on providing top-level care, get in touch with us here, or call us at 888-544-3537.

Sources

Cynar, M. (n.d.). Medical Billing Company Services – A Guide to Outsourcing. Medical Billing Service Review. Retrieved September 19, 2021, from https://medicalbillingservicereview.com/medical-billing-company-services/.

In-House vs. Outsourced Medical Billing: Pros & cons. 360Connect. (2020, October 20). Retrieved September 19, 2021, from https://www.360connect.com/product-blog/in-house-vs-outsourced-medical-billing/.

Malvik, C. (2019, April 15). What is a Medical Coder? An Easy Explanation of this Healthcare Career. Rasmussen University. Retrieved September 19, 2021, from https://www.rasmussen.edu/degrees/health-sciences/blog/what-is-medical-coder/.

Medical Coding Classification Systems. MedicalBillingandCoding.org. (2019, September 6). Retrieved September 19, 2021, from https://www.medicalbillingandcoding.org/qnas/what-are-the-different-types-of-medical-coding-classification-systems/.

Stahl, G. (n. d.). The Difference Between Keeping Your Medical Coding &Billing System In-House and Outsourcing. Healthcare Revenue Cycle Management Services. Retrieved September 19, 2021, from https://www.eclathealth.com/blog/the-difference-between-keeping-your-medical-coding-billing-system-in-house-and-outsourcing.