Offshore outsourced medical billing has become the right choice for many healthcare institutions and private practices. Outsourced medical billing not only helps organizations reduce operational costs, but it also increases revenues and allows health professionals to focus on providing high-quality care to their patients.

Below are some offshore outsourced medical billing case studies and success stories:

Outsourcing Medical Billing Improves Productivity

A radiology management group in the U.S. East Coast was struggling with billing-related issues, such as improper dictation and excessive backlog of outstanding charges. The company also had poor-quality images that led to entry errors when inputted into the management software. This radiology practice, which serves multiple groups of physicians, decided to team up with a medical billing outsourcing firm. They outsourced services for charge entry, demographic registration, medical coding, and for accounts receivables (AR) follow-up.

The outsourcing firm improved productivity by working closely with the client to identify key issues to solve:

First, they improved image resolution to reduce charge entry and demographic errors. They also organized medical reports for easy retrieval and suggested improving dictation reports to increase reimbursements. Second, the operations and IT team worked together to create a tool to improve accuracy, efficiency, and productivity. They also deployed a quality assurance team to validate processed files. Finally, the outsourced billing team sent updates on specific insurance company policies to the client. 

Because of the procedure established by the outsourcing company, the client was able to process about 7000 CPTs on a daily basis with very minimal errors (0.5 to 0.75 percent). The number of clean claims billed to insurance companies increased significantly, and the turnaround time was reduced. This considerably improved productivity. The client was also able to understand financial trends better due to data-driven reporting provided by the outsourcing firm.

Private Practice Increases Revenue with Medical Billing Software

A private family practice wanted to improve the tracking of patients that were on and off protocol. They also wanted to implement an operational procedure that would make sure protocols were followed. They needed a reporting tool that would work well with their existing EMR software, so they decided to outsource with an established medical solutions provider that would provide the proper technological resources for their needs.

The service provider used the help of software vendors to rework and organize the old data set and integrate the new information into the custom reporting tool via EMR. The new data showed in detail which patients were on and off protocol and the actions required to bring them back on protocol. It also portrayed which staff members needed to be trained so that they ensured a proper protocol follow-up.

As a result of an effective reporting system, the private practice increased the percentage of patients on protocol from 60 to 90 percent. The reconciliation and paperwork time was also drastically reduced from many weeks to less than two hours. By keeping patients on protocol, the firm also increased revenue on diabetic patients by over $2500 every month. Another benefit of the outsourcing partnership was the reduction of litigation risk for patients off protocol.

Internal Medicine Practice Improves Cash Flow through Outsourced Medical Reporting

An internal medicine practice was having difficulty driving revenues. They decided to partner up with a medical management outsourcing firm to uncover why the company was not having proper cash flow.

The outsourcing firm took over the client’s entire billing process. They found a high number of claims not being processed in a timely manner and a significant amount of disregarded claims. Within three months, the outsourcing firm stabilized the cash flow and increased collection percentage by over 9.8 percent within one year.

The client’s A/R cycle was also reduced by 11 days, leading to improved revenues and profitability. Besides these improvements, the outsourcing firm developed custom reports, such as reimbursement analysis to generate data, and insights to improve processes for the long term.

Building an Effective Outsourced Medical Billing Strategy

Outsourced medical billing services range from simple low-level tasks like data/charge entry and claims scrubbing, to more complex billing services, such as revenue cycle management and strategic consulting and planning. Most organizations outsource a minimal amount of billing services, and for the most part, opt for the simplest tasks. However, as companies start to seek more value from their outsourcing relationships, the number of businesses using a combination of complex and simple billing services is expected to increase.

The outsourced medical billing process is straightforward. The third-party firm provides capture and entry services by gathering claim information from electronic or paper patient records. These documents are scanned and sent to the billing team for validation and processing. If the practice is using EMR software, information is then sent electronically to the outsourced billing team and the insurance company.

Third-party medical billers provide and utilize proper software to streamline the billing process. They are responsible for submitting claims to the insurance company, following up on these claims, sending invoices to patients, appealing denied claims, managing delinquent accounts, posting payments, and handling financial calls from patients. As payment for their services, the outsourcing firm usually takes a cut from the practice collectionsis an indu. This represents an industry average of about 5 to 10 percent.

Effective Medical Billing Offshore Outsourcing

When planned and managed properly, outsourced medical billing can transform healthcare organizations. However, many practice owners, physicians, and managers are unsure whether the business can really benefit from offloading billing tasks to a third-party provider. The alternative to outsourcing is building a billing and revenue cycle management team in-house, which has its own pros and cons.

For small practices and healthcare organizations that lack resources, outsourcing billing and accounts receivables (A/R) to an outside specialist makes the most sense. For larger or expanding practices, building an internal medical billing department can mean more direct control over processes.

There is no one-size-fits all solution. The best way to determine whether outsourcing can help achieve your goals is to take an honest look at your business. Careful evaluation will uncover issues and opportunities and help you decide whether parts of your revenue cycle or the entire process can be better performed by someone else.

In-House vs. Offshore Outsourced Medical Billing

Creating an elaborate outsourcing strategic plan can help you decide whether outsourcing is the right call for you. This plan should identify all resources that can drive your business to a competitive advantage. The plan should also include a traditional cost-benefit analysis. Information derived from strategic planning can help you determine if outsourcing will help your business deliver long-term value for patients and improve profitability.

Cost

Cost remains the top reason companies across industries outsource certain functions. The same is true for medical billing. For many practices, working with a third party that provides medical billing services can reduce their total costs significantly. Outsourced medical billing can help a practice grow its gross collection rate by 5% to 15%.

Technology

In-house billing means investing in the right hardware and software per employee. A typical practice can spend over $10,000 on hardware and software (upfront cost of a software system not included). With outsourced medical billing, the third party provides or develops necessary tools that can be integrated with existing ERM software, thus reducing overall IT costs.

Skilled and Affordable Medical Billing Professionals

Building an internal billing department is expensive for any company.

Labor costs, benefits, taxes, training/support, and human resource expenses for two medical billers can easily exceed $100,000. Finding skilled medical billers can also be a problem in certain areas. Outsourced medical billing can cut these costs drastically through economies of scale and by leveraging high-quality, low-cost talent in emerging locations. Outsourced medical billing also provides immediate access to the most qualified and committed professionals in the area.

Should You Outsource Medical Billing?

Based on these comparisons, outsourcing medical billing is a wise business strategy: it has the potential to increase the percentage of revenue collected per year, and it provides immediate access to skilled and affordable medical billing professionals and best-in-class technology. However, working with a medical billing outsourcing firm makes sense only if the firm improves collection and revenues.

Every practice is different, and solutions must be customized to fit changing business needs. That said, not all practices want to reduce costs; many healthcare organizations want to improve inefficient processes. For example, an in-house EMR tool that integrates into the company’s current management software can reduce errors and duplication significantly while increasing transparency and revenues.

Practices that are ideal candidates for medical billing outsourcing are those that need to:

1. Improve billing process efficiency
2. Reduce employee turnover
3. Hire top medical billing professionals
4. Deploy the right technology
5. Focus on patient care

A new practice or business can also benefit from outsourced help. Medical professionals and new business owners have a lot to learn about running an efficient in-house billing operation and other administration tasks. Although it’s important to understand the basics of medical billing, a medical outsourcing provider can fill the knowledge and skill gap to improve profitability while physicians and medical professionals focus on providing high-quality patient care.

The decision to outsource medical billing ultimately depends on the company’s goals. Studies show that outsourced billing provides a higher net return compared to in-house billing. The key is to develop an outsourcing strategy that addresses priority issues, keeps costs down, increases profitability, and improves the quality of service.

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