Five Benefits of Outsourcing Your Ophthalmology Billing

By Michael Carroll on August 16, 2018

Consulting. Outsourcing. Third-party vendors. Contractors. Whatever you want to call it, businesses from every industry are getting help with services that used to be handled in-house. The same is true in the medical industry, and billing is one area that has seen a wide-spread transition to outsourcing in recent years. Is it worth it? Many experts and professional organizations say, “yes.” Medical practices face a revenue cycle process that is more complex than ever before. The Healthcare Business Management Association (HBMA) explained, “It takes the specialized skill of medical billing professionals to ensure your practices’ economic success and compliance with the many government regulations. Billing is no longer something someone does to fill in the time between scheduling and room patients.” Should you look for a billing partner for your practice? Here are five key advantages to outsourcing your ophthalmic billing.

  1. Avoid billing errors. HBMA estimates that practices that do not have sophisticated claim scrubbing software can have a claim rejection rate of 35 percent or higher. Medical Practice Management Resources(MGMA) puts the cost of processing each denied claim at $25. Even more alarming, 50 to 65 percent of denials are never worked. Thus, that money is never collected. Depending on the size of your practice, MGMA estimates thousands of dollars are lost each month due to “unclean” claims. However, outsourced billing teams have one purpose, that is to increase the profitability of your practice. Their highly-trained team tracks each claim throughout the process, ensuring that claims are submitted correctly each time, and that carriers, patients and government entities are paying the right amount.
  2. Improve cash flow. “Clean” claims mean faster payment. When claims are submitted correctly the first time, delays are unlikely. However, submitting claims to insurance carriers quickly is only half the problem. Since 2006, high-deductible health plan enrollees has increased six-fold, placing more of the financial burden on the patient. It’s no wonder that medical bills account for almost 40 percent of unpaid debt collection. When bills are sent in a timely manner, practices are more likely to get paid whether the claim is going directly to the patient or a third-party payor. As a result, practices can make more accurate revenue projections and keep cash flowing. Additionally, when you have an in-house biller, interruptions are bound to happen. People get sick, or they go on vacation, negatively affecting the timeliness of your reimbursements. However, claims should be submitted daily. Read more about why in this blog. Outsourcing your ophthalmic billing allows for a continuous flow of claims going out and cash coming in.
  3. Ensure compliance. Medical billing requires constant education and vigilance. Changes in Medicare, Medicaid, third-party insurers, as well as government legislation make healthcare a constantly evolving industry. Billers must be dedicated personnel that keep up with daily bulletins, communicate regularly with payors, and attend industry seminars and webinars. Compliance is so important that large health systems now have formal compliance programs in place. According to the Healthcare Financial Management Association (HFMA), one-third of health care providers estimated their annual budget for compliance is between $1 and $5 million. The cost of a compliance program is about $222 per employee. However, the cost of non-compliance averages out to about $820 per employee. Ensure compliance, avoid the high cost of non-compliance and implementing a compliance program by entrusting a billing company with the task. A billing company gives the practice access to a large, combined knowledge base of experts that work hard to keep up with their ever-changing field.
  4. Increase your bottom line. By relying on a billing company that’s focused on maximizing collections, it makes sense that profits would increase. However, that’s not the only reason profits increase. Leaning on a billing company reduces overhead. Getting paid faster + less administration work from practice staff + minimal money spent on in-house training = increased profits. The Society for Human Resources Management (SHRM) estimates it costs just over $4,000 to recruit, hire and train a new employee. Now consider the lag in collections when that person is out of the office, or quits. The average time to fill a position is 42 days. The complexity of the revenue cycle process makes it impossible for someone else to just “fill-in” and maintain the same level of productivity. A full-time professional is needed to manage billing. Simply put, medical billing companies are advantageous because they operate on an economy of scale. The cost to individual clients is kept low because of a high volume of production with overhead costs that are spread across multiple clients. Practices gain access to highly skilled teams that they normally couldn’t afford to put on their payroll. For a further cost comparison, check out this cost analysis done by Physicians News Digest.
  5. Improve patient care. Outsourcing allows providers and their staff to focus more on patient care, increasing patient satisfaction. Using a billing company relieves front desk staff of the burden of billing and collections, boosting productivity, efficiency, and employee morale. Patients with financial issues can talk directly with professional medical billing staff instead of interrupting workflow for front desk staff and making an uncomfortable environment for other patients. Inefficient billing practices can leave the patient with the impression that the office is unorganized. One healthcare news source said, “customer service can make or break a practice.” If patients don’t get competent information beginning with their first contact, they are less likely to trust the clinician too. Outsourcing medical billing ensures that your in-house staff is dedicated to meeting patient needs and to giving them the best experience possible. Additionally, when they have billing questions, they are greeted by a knowledgeable, competent team member.

In-house billing is fraught with challenges, including collection shortfalls and non-compliance issues. Reduce costs and increase profits by trusting a billing partner. Agnite Health is a cost-effective, outsourced billing company that offers complete solutions for both billing and collections. Our specialized team focuses on the needs of ophthalmology practices. Contact us to learn more about improving productivity and increasing revenue.