The medical billing process has evolved from a relatively simple back-office administrative duty to a sophisticated matrix. It has morphed into a system and workflow that requires subject matter experts in CPT coding, technology, claim filing, edits, managing denied claims, holding payers accountable, payer contracting, responsiveness to patients, compliance, and providing meaningful reports.

Most in-house processes have dedicated, well-meaning staff who are trying as hard as they can to support the billing process. Unfortunately, the nature of the process has changed so much that it is extremely difficult to have the necessary subject matter experts in place to manage the process and provide assurance that all the I’s are dotted and T’s crossed. This can create the unintended result of in-house billing processes not keeping up with best practices, industry standards, and regulatory compliance. Keeping an in-house billing process can be high risk with low reward. Below is a list of the benefits of outsourcing your billing services.

  • Revenue enhancement: A good medical billing service provider can often recover significant additional revenue. They have enhanced processes and safeguards to ensure accurate coding, clean claim filing, effective and timely denial management, holding payers accountable to their contracts, quality reporting, and follow-up.
  • Cost savings: Outsourcing billing should provide a savings even if the existing in-house operation is currently doing everything it is supposed to be doing.
  • Reduced responsibility: Outsourcing provides a provider a single point of responsibility to manage your billing process. No longer will you have to manage individuals doing the billing, make sure claims are filed timely and correctly, or deal with issues regarding the adjudication process. No longer will you have to directly be involved in hiring, training, and managing employees or make decisions as to when new software or hardware systems are needed to handle the billing process. This allows you to focus your time on your clinical work and delegate these administrative activities.
  • Consistency: You no longer have the hassle of cash flow variances related to an employee taking a medical leave, being on vacation, or vacating their position. There will be consistency with your charges being entered and filed with third party billers, and this will result in consistency in your cash flow. Other elements of the billing process that are performed consistently will further smooth your cash flow and recover lost revenue.

When fully assessing the potential lost revenue, the cost to stay current, the challenges of having strong subject matter experts in every billing competency, compliance, staying advanced technologically, and myriad other issues, it is very difficult to support a compelling argument for continuing to take responsibility for in-house processes. Aptus Associates is here to help your radiology practice with all billing needs. Contact us at 888-760-2455 or [email protected] to let us alleviate the ever evolving world of medical billing.