How Outsourcing Medical Billing services reduces billing errors:
The article aims to show how Outsourcing Medical Billing services helps reduce billing errors.
Errors in medical billing cost a healthcare provider a significant amount of money.
The healthcare service market has both high demand and associated healthcare costs, and making billing errors like these pose a risk for healthcare providers.
Healthcare providers simply cannot afford having and correcting a billing mistake that could have been avoided in the first place.
“…The Medical Billing Advocates of America (MPAA) and CoPatient…place the [medical billing error] rate at a higher estimate – closer to 80 percent to 90 percent.” – HuffPost
Although there is no definite error rate for medical bills, an unpublished research conducted by Stephen Parente, a professor of health finance at the University of Minnesota who has studied extensively on medical billing and its error rate, showed a conservative estimate of 30 percent to 40 percent of all bills except pharmacy bills, while there are groups such as Medical Billing Advocates of America (MPAA) and CoPatient that regularly review patients’ medical bills who place the rate at a higher estimate – closer to 80 percent to 90 percent.
What are the causes of medical billing errors?
There are a lot of reasons that cause errors in medical billing. The most common are:
- Incorrect patient information
Incorrect details such as policy number, patient status or a patient’s contact information or insurance ID details have been entered.
- Double billing
Also called duplicate charges, this happens when a service or product is billed twice by the provider.
- Incorrect coding
Medical codes are incorrectly entered by the designated medical coding specialist. Because of changes in the system, another reason for this incorrect code is that the code may have been removed or updated.
Another cause is upcoding wherein incorrect codes are used by the provider to get a higher payment amount for the services rendered.
There are procedures that are bundled and must be charged in a specific code. However, sometimes providers separate these bundled services for each to incur individual charges.
- Balance bills
If a patient is charged for amounts outside of the amount owed by the insurer based on the patient’s health plan.
- Charges for miscellaneous expenses
- and more
For practices that want to reduce these types of errors in medical billing at a practical cost, outsourcing services to a third-party provider is a viable option.
Medical billing outsourcing is a term used by healthcare practices who want to assign services, particularly non-core business functions, such as scheduling and billing requirements, to third-party providers.
Outsourcing medical billing allows access to healthcare support from medical billing professionals to improve billing operations.
The global medical billing outsourcing market size was valued at USD 11.1 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 12.0% from 2022 to 2030.
The most common cause of mistakes in medical billing is human error, such as incorrectly typing in the wrong billing code.
Medical Billing Outsourcing providers lets practices hire experienced healthcare staff such as medical billing specialists to review that the data entered from the claim form is accurate and complete to enable the claim to be processed correctly.
Outsourced staff use cloud-based billing and connectivity platforms and telephony systems integrated by the outsourcing provider technology to support medical billing services.
Medical billing outsourcing providers establish and maintain the security of medical records to ensure patient confidentiality and private data on an ongoing basis. This provides patient satisfaction.
Aside from this, medical billing outsourcing providers verify and review a patient’s insurance claims on a daily basis for accuracy and follow professional standards to meet requirements of local, state, and federal regulations.
They also ensure coding medical documentation for insurance claims such as assign CPT, HCPCS, ICD-10-CM, and ASA, APC and DRG codes to ensure the patient is properly billed for their medical treatment.
As a result, practices receive timely payments and error-free medical billing.
Outsourcing medical billing and other healthcare administration functions in general, lets practices improve medical billing process, increase the number of clean claims and reducing billing errors, non-payments and denials.
Aside from outsourcing medical billing, practices can also outsource other administrative healthcare functions.
Outsourced Medical Administration staff practices can hire other healthcare related roles such as:
- Prior Authorization Specialist
Outsourced Prior Authorization Specialists conduct can be assigned functions such as submitting and following-up preauthorization to various insurance companies.
- Data Analyst
Data Analysts are responsible in examining and deconstructing complex practice data sets based on a set criterion.
- Medical Claims Adjudicator
These Medical Claims Appeals staff are in charge of checking claim statuses online, correcting denied claims, resolving discrepancies and processing refund requests or settlements, and sending corrected claims.
- Virtual Nurse
Virtual Nurses are responsible for patient assessment, as well as planning of care and subsequent recovery. They are also able to work closely with health care practitioners to ensure the recovery of patients.
- Patient Care Coordinator
Patient Care Coordinators act as the first point of contact of patients. They make follow-up telephone calls to maintain accurate records and interact with the patient.
- Patient Scheduler
Patient Schedulers assist patients in preferred communication channels such as calls, emails, messaging and walk through the terms of service, insurance coverage, and payment options. They also assist patients on their scheduled appointments or treatments and consultations.
- and more
- The healthcare service market has both high demand and associated healthcare costs, making billing errors like these costly and a challenge for practitioners.
- Medical Billing Outsourcing providers lets practices hire experienced healthcare staff such as medical billing specialists to support their operations.
- Medical billing specialists review that the data entered from the claim form is accurate and complete to enable the claim to be processed correctly, resulting in patient satisfaction, timely payments and error-free medical billing.
Connext Global Solutions is a business process outsourcing company that provides fully customized outsourcing solutions for healthcare organizations looking to improve healthcare operations.
Outsource Healthcare services to Connext today.
Ann Brenoff. There’s A Strong Chance You Are Paying For Expensive Medical Billing Mistakes. “There’s a reason you can’t understand your hospital bill. Nobody wants you to.” Huffington Post. May 17, 2017. https://www.huffpost.com/entry/nearly-90-percent-of-medical-bills-contain-mistakes_n_5902146be4b0af6d718c6e80.
Arthritis Foundation. Common Medical Billing Errors. https://www.arthritis.org/health-wellness/treatment/insurance-management/toolkit/common-medical-billing-errors
Medical Billing Outsourcing Market Size, Share & Trends Analysis Report By Component (In-house, Outsourced), By Service (Front-end, Middle-end, Back-end), By End-use, By Region, And Segment Forecasts, 2022 – 2030. Grand View Research. https://www.grandviewresearch.com/industry-analysis/medical-billing-outsourcing-market.