Medical billing or revenue cycle management is integral components of practice administration. The better a practice manages its billing, the better it gets paid. Given the regulatory and compliance challenges within the healthcare industry, physicians today are overburdened as it is and thus require an efficient billing manager to manage the day to day operations swiftly. However, most solo practitioners unfortunately lack the resources to employ expert personnel and in such cases have to manage the process themselves.
The initial development in health IT was in fact to provide a solution that would resolve the problems associated with medical billing. This is partially the reason why you might find a practice management system but not an EMR in most practices. Payors are not charitable organizations working to make the world a better place; they are businesses developed with the purpose of earning profits. As the healthcare industry rapidly moves towards evidence based practice methods and performance based reimbursement, EMR billing becomes essential. While payors may remain reluctant to reimburse claims, having quality documentation processes will undoubtedly expedite the process.
Established EMRs offer e-billing and claim management built-in to their solution with physicians stripped for cash opting to utilize these systems themselves or have the office manager take care of it. While e-billing simplifies the process it can still be taxing, hence outsourcing this process to a team of specialists becomes a viable option. In comparison to having an in-house team, an outsourced billing process does in most cases prove to be more cost effective. In a study by software advice, collections are likely to improve by 10% through outsourcing. While costs may decrease slightly in the initial period, they are likely to equalize to that of employing an in-house team in the longer run.
Outsourcing models such as pay-as-you-go are more likely to attract attention, with a fixed percentage of the eventual re-imbursement that physicians receive. This ensures that the provider does not have to make payments when short on cash. However, reduced cost is not the only benefit; providers that start up can benefit more from such services as they do not have to recruit their own back office departments. Outsourcing also works for physicians that do not want to deal with the business side of running a medical practice. Lastly, outsourcing eliminates workflow disruption that may occur due to staff turnover. The billing process is likely to become more complex over time, thus outsourcing is likely to become a practical option for practices of all sizes.
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