Complete Versus Partial Medical Billing Outsourcing – What’s the Difference?

As a medical practice, you can outsource medical billing tasks to specialized billing companies or professionals. Outsourcing these tasks can help streamline operations, improve revenue cycle management, and reduce administrative burdens. This you already know. But you probably don’t know that medical billing outsourcing is not an ‘ all or nothing’  proposition. You can choose to outsource some aspects of the medical billing cycle.

Complete Medical Billing Outsourcing

A complete medical billing outsourcing agreement is when you hand over the entire billing process to your medical billing service. This includes – insurance eligibility checks, prior authorizations, claims submission and follow-up, denial management, payment posting, and reconciliation. In addition, you may also outsource related tasks such as provider credentialing, patient billing, and A/R collections.

Partial Medical Billing Outsourcing

Complete medical billing outsourcing may not be for everyone. As a large medical group, you may already have an existing medical billing team.  Although the economies of scale are much more in favor of outsourcing the process, you may prefer to keep the process in-house. Another scenario is that low billing volumes may not justify medical billing outsourcing for a small or new practice.

For both of these cases, partial medical outsourcing is a perfect solution.  Partial medical billing outsourcing is when you outsource certain medical billing tasks instead of the whole process. Some processes that could be outsourced piecemeal are – provider credentialing, A/R recovery, insurance eligibility checks, and prior authorizations.

Partial medical billing outsourcing is ideal for a growing medical practice or group wanting to scale the billing function rapidly. So rather than doing everything by yourself, you take the help of billing professionals.

Advantages of Partial Medical Billing Outsourcing

The advantages of partial medical billing outsourcing are as follows:

• It is easy to implement and improves the efficiency of your existing internal processes.
• Support your existing medical billing team without adding significantly to your administrative costs.
• It allows you to assess the learning gaps within your medical team.
• It is a staggered approach to assessing whether complete medical billing outsourcing is right for your enterprise.
• Scaling up ( or down) operations with an outsourced team is easier.
• It allows you greater leeway to focus on practice growth and patient care.

Top Medical Billing Tasks Which You Can Outsource Almost Immediately

So, do you want to know the tasks most suited for partial medical billing outsourcing?  Here are our top 5 picks:

1. Provider Credentialing and Enrollment

Is your healthcare organization experiencing an uptick in out-of-network claims or facing diminished insurance payouts because of provider non-participation? These could indicate underlying inefficiencies within your medical or group practice’s provider credentialing procedures. Delays in the provider credentialing process can harm patient scheduling, claims reimbursement, and overall cash flow management.

Conversely, an optimized credentialing process can improve these areas and significantly boost your practice’s financial performance. Ensuring timely and seamless provider credentialing is paramount to upholding the reputation of your medical practice and is also crucial from a compliance standpoint.

2. Insurance Eligibility Verification and Prior Authorization

The foundational steps for efficient medical billing are insurance eligibility verification and prior authorization procedures. However, navigating through insurance verification checks can be intricate. Likewise, securing prior authorizations demands close coordination with patients, payers, and other providers.

Both processes are time-consuming and distract the practice staff from delivering a superior patient experience.

3. Patient Demographics Entry

Getting the basics right can significantly impact your medical practice’s profitability! In revenue cycle management, the fundamentals begin with the accuracy of patient demographics entered into the practice management system. Accuracy at this stage is vital to your practice getting paid and ensuring patients get their bills and other communications from your practice. Demographics are vital data for implementing value-based healthcare and improving patient care.

4. Medical Coding

Given the extensive roster of over 68,000 ICD-10-CM codes, attaining precision in medical coding presents a formidable challenge for healthcare enterprises. Outsourcing this task gives you access to a team of certified and experienced AAPC and AHIMA-certified coders. These coders have the technical knowledge and vast coding experience, having worked for multiple healthcare enterprises.

5. Charge entry and claims submission

Inaccuracies during charge entry can result in claim denials, underpayment for services rendered, or the medical practice overbilling its clients. This, in turn, can trigger substantial revenue losses, patient dissatisfaction, and potentially even compliance concerns for the medical practice.

These are only a handful of medical billing tasks you can outsource to experience immediate and significant benefits in your overall medical billing and revenue collection efforts. And as stated earlier, the scale of outsourcing depends entirely on the unique needs of your medical practice.

PracticeForces has a team of certified and experienced virtual remote assistants who can take on these RCM tasks for you. Outsourcing will free up time for your in-house billing team, allowing them to focus on patient communications and payment collections. So, it’s a win-win for you, your staff, and your patients.

Interested in outsourcing part of your medical billing? Let’s connect today to improve the efficiencies of your existing in-house billing processes. Office tasks which you can outsource to PracticeForces include:

1. Provider credentialing
2. A/R recovery
3. Insurance eligibility checks
4. Prior authorizations
5. e-RX eligibility and authorization
6. Demographics data entry
7. Payment posting and reconciliation.

You can outsource any of the tasks listed above or a combination of tasks.