Research Shows the Outsourcing Medical Billing Market Will Increase

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According to the Global Medical Billing Outsourcing Market Size study, the global medical billing outsourcing market was worth US$10.2 billion in 2020 and is projected to register a compound annual growth rate (CAGR) of 12.6% during 2021-2027.

Some of the driving forces behind this projected growth come from the pandemic and private physicians needing to trim their budgets and generate more income.  The industry was struck hard when the ability to see patients in person was derailed by COVID 19 and fear of being exposed to the virus kept patients home. The drop in some physicians’ revenue, according to research, was as much as 50%, but on average was about 30-35%. Physicians will be looking to save on overhead costs and make up some of their lost revenue by outsourcing their medical billing.

Another reason is the shortage of healthcare workers. The pandemic has seen an unprecedented reduction in workers while seeing an increase in the need for medical care, both due to COVID infections and in the specialty area of mental health.  For example, the two states most impacted by the pandemic are New York and California. These states may see their labor forces drop by as much as 500,000 by 2026. However, patient visits are estimated to increase by another 10% by 2026. Outsourcing will be a way to eliminate the void left by the staffing shortage and keep cash flowing into practices.

Medical billing is an important part of the health of a medical practice and ensuring that it is executed successfully is critical. Although it may seem counter-intuitive, outsourcing medical billing can be the answer. Looking at the overall cost of salaries, benefits, and continually training staff to keep up with this complex job, having an outside company that focuses solely on medical billing can actually save you money. It can also give your office staff back critical time, allowing them the ability to provide a good patient experience. Not having to be divided between following up with payers on medical claims and handling patients can increase the happiness of not only your patients but your workers as well.

Here is a list of benefits that can come from outsourcing your medical billing.

  1. Reduces Billing Errors. A medical billing company’s sole responsibility is to ensure they provide exceptional medical billing services. Which means staying compliant and up to date on the most current medical codes and payer guidelines. This helps to reduce the number of denials and rejected claims due to billing errors. They can also provide feedback to help maximize income from future claims.
  2. Improves Cash Flow. Most practices have only a few people that handle their medical billing, some only have one. What happens when your biller goes on vacation, gets sick, or worse leaves? Medical claims have to wait and cash flow slows down. By outsourcing to a medical billing services company you never have to worry about that as they have teams dedicated to ensuring your claims go out promptly.
  3. Ensures Billing Compliance. We all know that healthcare is an ever-changing industry. Keeping up with Medicaid, Medicare and private payers is what makes billing complex and hard to stay on top of. Since all medical billing service companies do is focus on the billing cycle they have to stay up-to-date on the latest in government regulations and private payer guidelines in order to maintain compliance and the submission of clean claims.
  4. Increases Revenue. Understanding that by outsourcing your billing you can save money on overhead expenses such as salaries, benefits, training, office space, and supplies, you can see how there would be an increase in revenue. Also, outsourced medical billing service companies can help you clarify your medical claims to ensure you are obtaining the most reimbursement for your patient care. This is done by reviewing documentation and pointing out modifiers that should be listed based on the notes. And by getting clean claims out on time, you will also see an increase in revenue due to fewer claim denials.
  5. Improves Patient Satisfaction. Having to handle both billing paperwork and face–to–face patient interaction can be challenging at the best of times. Reducing the stress on your staff by removing the burden of medical billing frees them up to provide exceptional customer service and focus on what is important – the patient’s experience.

How Outsourcing Your Medical Billing Can Impact Your Bottom line?

We understand that the decision of hiring a medical billing company requires a great deal of thought. We also know that outsourcing can positively impact your bottom line if you partner with the right company. You can lower your overhead expenses and increase your cash flow. With an entire medical billing team focused on your revenue cycle management, your internal staff can focus on providing quality patient care.

Let Billed Right become your strategic partner. With over 15 years of experience handling a variety of medical specialties, we understand all the pain points and how to eliminate them from your daily workflow.  From understanding claim profitability, navigating complex payor rules, keeping up-to-date on everchanging reimbursement methodologies, and analyzing denial trends impacting your practice, we partner with you to navigate all the facets of the revenue cycle.

Contact Billed Right today to learn how we can be your strategic partner and not only increase your revenue but grow your practice.

 

 Six Tips to Avoid Telehealth Claim Denials

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The pandemic brought with it a shift in how medical care is carried out. Due to the fear associated with catching COVID 19, the rules surrounding telehealth were relaxed. As a result, it brought telehealth to the forefront, and providers were able to care for their patients even through the stay-at-home orders and social distancing mandates.

With telehealth becoming a growing topic for providers, payers, patients, and the overseeing governmental agencies, attention needs to be paid to ensuring that providers are getting reimbursed correctly.  Research shows that by 2020 there will have been an estimated 158.4 million telehealth video sessions compared to just 19.7 million in 2014.  Even with the relaxation of rules and regulations around telehealth services the billing process can be complex as the guidelines are constantly changing and will more than likely change again once the public health emergency has been lifted.

There are several things providers should do to ensure they are filing telehealth medical claims correctly:

  1. Verify exact coverage – Medicare has listed the services covered under the Medicare Physician Fee Schedule however, not all commercial payers follow this list. Your best option is to call and verify each payer’s telehealth policy to ensure it is covered. Questions to ask could include:
    • What telemedicine health care services can be done?
    • Is live video telemedicine specifically covered?
    • Are there limits on the total number of telemedicine visits the patient may have each year?
    • Are there conditions that must be met, or restrictions, before patients qualify to be covered for telemedicine services? (Ex: established patient vs new patient, patient consent in writing, specific distance from provider)
    • What are the specific CPT codes that are considered payable when services are provided via telehealth?
  1. Documentation requirements – Although most payers are required to cover telehealth visits at the same or similar rate as in-person visits, they may have different requirements on how to document the visit so it is important to research each payer’s guidelines.
  2. Accuracy in coding – Unfortunately, not all payers follow the same rules, so like with your standard in-office billing, you must be diligent and understand what code is appropriate when billing for telehealth.
  3. Make a list – Compile a list of all payers along with any specific requirements for POS codes or additional documentation. Having this at hand can help to ensure you are coding claims correctly thus lessening the opportunity for a claim denial.
  4. Monitor denials – Like with all denials, monitoring telehealth claim denials will allow you to avoid continuing to make the same mistake or give you a heads up that a payer has changed their policy. Denials may be the only way that you know if something has changed. Also, should a claim be denied, make sure you file a timely appeal to ensure you don’t lose revenue.
  5. Keep up – Things are changing rapidly and therefore require you to stay informed on any new rules, regulations, or laws pertaining to telehealth services.

 

As telehealth becomes more utilized we can hope that a set of clear guidelines and rules will get adopted across payers. Until then being vigilant through the entire telehealth billing process is what it will take to ensure correct and timely reimbursement.

Technology advances are happening daily and the demand for flexibility and convenience is growing. The benefits of telehealth and telemedicine will continue to increase and remain an integral part of healthcare, which is good news for patient outcomes, care continuity, and chronic care management.

How Billed Right Can Help

With the ever-changing landscape, it is important to have someone who is keeping up with the new rules and guidelines. That is where Billed Right comes in. As a strategic partner, focused on ensuring that your medical billing is done correctly and on time, utilizing our revenue cycle management services can take the burden off your staff.  We employ AAPC certified coders and experienced medical billers to ensure we maximize your revenue potential and keep you educated and updated along the way.

Contact us today to learn more about how outsourcing your medical billing with Billed Right gets you a strategic partner focused on growing your business and optimizing your operational management.