Medical billing is a complex process that requires the focus of skilled, certified billers and coders who are trained in the procedures that facilitate a healthy revenue cycle and prompt reimbursement for a healthcare facility. If you are struggling with timely filing, delays in receiving reimbursement, or staff burnout, you may need to consider outsourcing your medical billing. Here are the signs that may take you one step closer to outsourcing your medical billing and revenue cycle management.
1. Strains on Your Administrative Staff
Healthcare is a dynamic, challenging industry, and requires a special team of highly trained clinicians and administrative personnel to accomplish many tasks related to patient care. Burnout is not uncommon in healthcare, and if your staff feel overworked or strained to complete their work, you will see a higher rate of turnover and dissatisfaction in your organization. Medical billing is not immune to turnover, as a facility’s focus on revenue-centered results places pressure on billers and coders to push high volumes of claims in shorter time frames, with a high level of accuracy.
If you are seeing inconsistencies in your revenue cycle, such as issues with your accounts receivable (A/R), timely filing, or an increase in denials, you may have staff who are struggling to keep up with the demands of the work, and may choose to leave your organization. Hiring and training new staff is a costly affair, as you need to find the right fit – someone who is certified and highly trained, and can manage your expectations. Where revenue is concerned, you must set your expectations high, and the demands of your medical billing team will subsequently increase. Keeping a tight-knit billing staff in a facility is tough, so if you are feeling the strain of losing employees due to burnout, it may be time to choose an outsourced medical billing company that focuses solely on medical billing and coding – and nothing else.
2. Delayed Payments
Healthcare facilities need prompt payment from medical claims to operate effectively, but if claims are not paid in a timely manner, the denied claim workload for your medical billing team increases and creates additional strain. Denied claims are the number one reason for a delay in payments, and could be related to several factors such as overworked staff – which can result in a high rate of billing or coding errors, or having to constantly train new clinicians or staff.
The decision to outsource medical billing is a step in the right direction; you are choosing to have a group of highly trained professionals to take over your claims review process. By placing your trust in a medical billing company, you are facilitating success as your new medical billing company will ensure a high rate – as much as 99% – of clean claims, which significantly decreases the number of delayed payments.
3. Decline in Clean Claims Percentage
Clean claims are simple to understand – they are a simple ratio – the average number of claims paid after the first submission. These claims are not stained by the delay of denials or long wait times in A/R, and the percentage should be 95% or higher. If your facility has a clean claims rate lower than 85%, your revenue cycle management strategy is lacking. Imagine 1,000 claims submitted, with only 850 paid after the first submission. This means 150 claims need to be reworked, rebilled, recoded, and resubmitted, which delays payment and could increase the number of days in your A/R as well.
The percentage of your clean claims rate is a byproduct of the work your staff is completing, so the lower your percentage, the more time your staff is spending on reviewing denials, communicating with payers, and fixing errors before submitting a claim for the second time.
Denials tell a compelling story about your revenue cycle management strategy. Your clean claims percentage could be telling you to re-write your strategy and outsource your medical billing.
4. Diminished Revenue
Healthcare facilities have a tough decision regarding medical billing when opening the doors for the first time, as there is little revenue to cover the cost of adding a vendor. If your facility is well established and has a good stream of revenue, it might be time to consider outsourcing your medical billing. There comes a time when the billing process outgrows itself and eventually costs more to keep it in-house.
The costs of outsourcing your medical billing could possibly equal the costs of keeping it in-house, but the better option is to move forward with outsourcing. An outside revenue cycle management company helps you convert the high, fixed employee costs to a variable expense that can be connected to revenue. Remember, if your revenue diminishes, you still have to pay your staff. Those expenses are fixed and cannot adjust with a loss in revenue.
Compare your revenue with the industry median; if you fall below the industry average, outsourcing could be the key to optimizing your revenue. A robust revenue cycle management strategy is an essential component of operational success for your facility, and ultimately reduces your operating costs.
5. Struggles Keeping Up with Regulation Changes
The government and other organizations, such as the Centers for Medicare and Medicaid (CMS) dictate the rules and regulations for medical billing. New protocols are constantly introduced by CMS and other third party payers, so it’s critical to ensure that medical billers and coders are consistently updated on changes that affect the billing process. Predicting these changes is not easy, but the changes are inevitable and expected.
Certified medical billers and coders in an outsourced company focus only on billing and coding, and are constantly updated on new information as it is disseminated by insurance payers and CMS. The information they receive ensures they remain compliant, are up to date on every regulation, and submit accurate, clean claims for your facility.
6. More Time Spent in A/R
Your facility must understand the many reasons a claim is rejected, but closer attention is required for the number of days a payment is sitting in accounts receivable (A/R), where money due from a claim waits. Medical billers are required to submit claims on time, so a facility should expect that reimbursement would be distributed on time. It’s important to review A/R on a monthly basis to flag payments that are older than 30 days, but the larger your facility, the more difficult it becomes for your in-house medical billing staff to focus on the time spent in A/R.
An outsourced medical billing company has teams that focus only on denials or A/R. Since they are not tasked with other facility responsibilities, the ability to track and manage A/R becomes less arduous.
7. Lower Quality of Patient Care
When your staff are overworked and stressed, they will not deliver excellent, quality care to patients. Managing medical billing is complex enough, so adding to the plate with extra tasks such as scheduling appointments and interacting with patients adds to a biller’s workload, and reduces their ability to function at an optimal level. When this happens, a patient’s expectations are not met, quality care is absent, and patient satisfaction rates drop.
Outsourcing medical billing takes the weight off your team. Let your staff focus on the main purpose of the facility – taking care of the patients, and let the outsourced company do what they know best – medical billing, coding, and managing your revenue cycle process.
Choosing Coronis Health for Your Billing Needs
Coronis Health combines years of expertise with a thirst for providing excellent customer service to ensure that your billing needs are addressed. We provide revenue cycle management services for laboratories and pathologists, behavioral health, hospitals and surgery centers, primary care and specialty physicians, FQHC and CHC services, anesthesia, and emergency medical services.
Additionally, Our team of certified billers and coders are dedicated to providing high quality services so you can focus on your patients. One of the best moves you can make for the revenue health of your facility is to outsource your medical billing or overall revenue cycle management process to Coronis Health. Contact us today for a financial checkup and find out why we are your solution to revenue cycle management.