Building a Solid Medical Billing Department

Does it seem like each year it’s becoming harder and harder to stay profitable with your medical billing? There are reasons, and we’ll explore them in this shifting paradigms article on Growing Your Medical Billing Department.

But first, be assured that a billing department with the right strategy and technology can turn the internal and external threats you’re facing into growth opportunities.

“Our industry is changing rapidly amidst a perfect storm of Meaningful Use,, ICD-10, and a host of new national players wielding advanced RCM cloud technology”

Physician’s needs are changing, and as their needs change, our roles and responsibilities as trusted business advisors have to adjust. While some billing businesses are growing leaps and bounds, others are shrinking and struggling to hang on. The goal of this paper is to deconstruct, identify, understand, and respond to the myriad of forces rapidly reshaping the changing landscape we call the medical billing industry – or Revenue Cycle Management (RCM).

There’s no question about the challenges you’re experiencing. There are times when continuing to do business the way you always have is an acceptable choice, but this is not one of those times. The threats to outsourced physician billing services using a traditional model are so severe that those who choose the status quo will not survive.

We’ll look at the causes of industry change, where companies are moving during the next few years, and the changing nature of the medical billing services industry. Then we’ll detail the internal and external threats to your business and outline ways to position your business to compete over any sized competitor and succeed.

The main reasons for outsourced growth are:

  1. Increasingly complex and onerous regulatory compliance
  2. Lack of resources within practices
  3. Dated technology that cannot properly integrate
  4. Difficulty finding and retaining talented coders and billers
  5. High levels of billing inefficiency.

Lost claims (more than 15%) and claims with mistakes (more than 30%), and denials due to eligibility, authorizations, or improper coding cause medical practices to generate more than $700 billion in administrative waste every year. While some billing efforts are growing, others are shrinking and struggling to survive. The medical billing sector is experiencing some significant issues. Specifically they are:

Highly fragmented

There are a huge number of small, under capitalized companies and a handful of larger players.

Extremely disjunctive

75% of billing services are using standalone medical billing software that cannot interact seamlessly with the medical office. Most billing companies still manually re-enter superbill data from their practices into these outdated legacy systems. A surprising number of billing services still use a version of software that is not 5010 compliant.

Ripe for shakeout

There are approximately 8,400 medical billing companies vying for physician’s outsourced billing, but only a small percentage are able to compete technologically with the giants in the industry. AthenaHealth reports possession of almost 25% of the medical billing market (and says it’s growing 27% annually).

MGMA reports that as much as 40 cents of each dollar a practice brings in is spent on administration, and physicians recognize that coding and financial administration is not their forte.

So, hiring experts (internal or external) to handle the time-consuming and problematic task of insurance billing is a sensible way to spend less time on business, more time practicing medicine, and (depending who they hire) keep more of money they’ve earned.


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