Revenue Cycle Management (Medical Billing and Collections) – Why Outsource?

medical billing revenue cycle management outsourcingCorrect, detailed physician documentation, coding and billing is and continues to be of the upmost importance as we continue to see healthcare and reimbursement changes. As an example, the Centers of Medicare and Medicaid Services (CMS) in 2017 will say “bye-bye” to PQRS, Meaningful Use, and the Value based Modifier- (kind of). There is a constant need to keep the industry aware of mandated deadlines, education and the work effort and time effort not to mention the cost involved. Industry changes are causing cash flow challenges for many of today’s medical practices.

Having a billing partner, an extension of your practice is of the topmost significance. Sharing of information, findings, trends, education and providing guidance in revenue resolution, how to increase profitability and stay in compliance is a role of a billing company.

Medical billing companies are able to save operational time and cost by leveraging the economy of scale and the efficiency of task specialization.  Additionally, since third party billers receive a fee based on collected receivables, they have an incentive to collect as much money as possible, as fast as possible.  The swiftness, accuracy and efficiency in which you turn progress notes to be coded and clean claims into payer reimbursed dollars will determine whether your practice will be healthy financially.

When evaluating the option of outsourcing your medical coding & billing the related cost of each option should be taken under consideration.  A proper analysis can exemplify a significant price difference between in house and outsourced billing services.  Some of the cost removed from the practice when outsourcing is:

Billing & Coding Staff Salary/Wages

Benefits to Staff – may be as much as 20% – 30% of salary – Need to consider health insurance, Social Security, Unemployment, retirement plans, vacation.  Peace of mind that the work does not stop even if a staff member is out sick, extended leave or on vacation.

Training Costs – it is of highest importance for medical billing staff and certified coders to stay current on healthcare industry changes, not only for compliance issues, but also to shield your bottom line. Continued education on governmental changes is of overriding significance. .

Billing Office Space – space could be used as revenue producing such as a procedure room or additional examination room.

Software/Technology Costpractice management systems and EMR’s have monthly/annual fees for use software use, support, annual maintenance, mandatory upgrades, interfaces, professional IT personnel.

Electronic Data Interchange (EDI) Cost – the providers charge is normally based on the volume of data transmission.  Some subscription models may be:  pay as you go, monthly or annual subscription. These costs can be substantial.

Some may assume that the cost of having an internal medical billing department will be less than the cost of outsourcing medical coding and billing.  Full service Revenue Cycle Management companies typically have rates from 4% to 8% of net collections.   Utilizing a medical billing & coding partner who employs certified coders, uses quality software to assist in the management of  accounts receivables, claims management, has a compliance plan, will not only reduce the cost to collect an invoice, but will provide consistent cash flow while increasing the performance of collections.  Often execution of effective revenue cycle management is a challenge to the average practice. It is critical for practices to be in the know on their financial health and how to improve payer reimbursements and collections.

MGSI, LLC (MGSI), is rated among the top 10% of RCM companies nationwide. We offer unique integrated solutions combining practice management software, electronic health records, mobile charge capture and document management.  Operating since the early 1990’s, MGSI has consistently been able to accelerate the claims process and dramatically reduce the time it takes to bill and collect a practice’s receivables. Contact us today @ 877-896-6474 or