No matter the size of your medical practice, having the right medical billing and coding services is essential. This system affects everything from day-to-day operations to the overall profit of your practice. Taking the time to find the best medical coding service for your practice should be at the forefront of your mind.
There are three main options for medical billing and coding: in-house, outsourced, and a hybrid approach. A hybrid model allows you to take advantage of technologies to support your in-house team. It also provides extra support for your existing team, acting as a back-up when you’re short-staffed or have staff turnover.
In this post, we’ll take a look at all three medical billing options and the advantages and disadvantages of each. We hope it will give you the information you need to make the best medical billing and coding choice for your practice.
Should You Build an In-House Team?
If your business handles fewer than 500 patients per month, in-house billing might be the choice for you. With the right staff and software, an in-house team can be time-efficient and productive. However, whether an in-house team works for you will depend on your practice specialty, the complexity of your billing and your team’s level of experience
To ensure your in-house team is as effective as possible, make sure they’re specialized. This means they are professionals who are focused on one component of the revenue cycle. This focus helps to ensure their work is always high quality.
Having a dedicated staff can also help you avoid costly mistakes and enhance your revenue cycles. With more billing and coding experience, your team can achieve higher reimbursements and quicker collection times.
But having an in-house team takes more than skilled employees. You’ll also need to give them tools to do their job efficiently. This means purchasing software that will help them streamline their billing process and manage time efficiently.
An in-house team may also require office space, which affects your bottom line. Even a remote team will need equipment and oversight — all adding up to a bigger budget.
Building an In-House Team: Pros & Cons
Pros
- You have a group of individuals who are familiar with your business (including its systems, goals and employees). This can mean less oversight because they will understand how the company functions. An in-house team may also be more committed to your business goals.
- An in-house team boosts communication; everybody at the business can easily connect, ask questions and work together on problems.
- If difficulties emerge, the accessibility of your in-house billing department is a huge benefit. All it takes to rectify concerns is a simple stroll across the office floor.
- Investing in an educated billing staff and billing software takes a lot of time and money. When considering switching to an outsourced model, think about the costs you’ve already spent on billing and whether you can modify current procedures to maximize ROI.
Cons
- A small in-house team can face challenging workloads, especially if any employees leave.
- An in-house team may have less access to high-quality technologies and medical coding programs. As you are already investing in their salaries, you might not be willing to spend too much money in software and tools, and your team may have to do a lot of manual work.
- It is often assumed that the costs of paying billers’ wages, covering employee benefits and procuring technological systems total more than what is typically paid to a third-party billing solution.
- If your billing department has just two or three employees, your operations – and cash flow – might be severely hampered when even one person becomes unwell, goes on vacation, takes a leave of absence or leaves entirely.
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Is It Better to Outsource Your Medical Billing and Coding Process?
If your team is handling a large number of patients, you may not have enough staff to handle the medical billing and coding process. This is when outsourcing becomes a good option.
There are a few things you should consider when looking for an outsourced billing partner:
- Make sure they are using high-end technology software and tools to get the job done: you need to take a look at the elements of your billing process (insurance validation, medical coding, claim submission, A/R follow up, etc.) and make sure the software they use will provide enough data to help you develop an efficient medical billing process.
- Ensure that they have a staff that is big enough to stay on target with timelines. Otherwise, you could end up with more costs tied to delayed coding, which could translate to unpayable bills.
- Ask for references with the billing company’s current or previous clients. Don’t forget to consider online reviews, too. These steps can help make sure you’re partnering with the best company possible.
Outsourcing the Billing and Coding Process: Pros & Cons
Pros
- Employees are more focused on their specialty: In bigger practices, the personnel who manage your billing and claim submissions may be committed completely to that position. But in smaller to medium-sized clinics, it’s possible the person who manages your billing has other tasks to worry about.
- Fewer leaks and lower overhead to increase revenue: You won’t lose money with a team who is completely focused on all your claims and payments. They can increase the amount of cash you bring in while perhaps cutting overhead expenditures owing to wages, software or blunders.
- Claims are far more likely to be filed properly: Third-party medical billers use automated procedures to convert your practice data into something very similar to a CMS. Then, they examine each claim for mistakes or omissions. Their staff is always on the watch for impending changes that may affect the way you submit claims. They are also proactive in shifting procedures to adapt to industry changes.
Cons
- Lost costs: Medical practices frequently spend a significant amount of time and money training billing personnel. Outsourcing to a third-party supplier may result in sunk expenses due to the resources you’ve previously committed to educating your employees.
- Enhanced risk: Healthcare firms have the greatest average cost per data breach of any industry, at $9.23 million per occurrence. It just takes one little misstep on the part of a vendor to reveal critical patient data and jeopardize your medical business. As a result, while choosing a vendor, privacy and security should be high priorities. It’s vital to work with a company that is up to date on industry standards like HIPAA and HITECH.
Lost Revenue Calculator for Medical Billing
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Is a Hybrid Approach the Best Option for Your Medical Coding Services?
With a hybrid approach, you can have a small in-house team of one to two people who work alongside a billing/RCM vendor. This gives your practice a break in terms of how many people you have to employ — you won’t need a staff member for every billing/RCM function.
A hybrid approach also allows your office staff to focus more on patient care — helping with check-in and check-out, answering questions and making sure patients know where to go.
The Hybrid Approach: Pros & Cons
Pros
- You’ll have all the tech and tools available to you via the medical coding and billing service while having a more transparent and efficient process with your in-house team.
- Your claim tracking will also be more accurate thanks to the software available through third-party medical coding platforms.
- With multiple teams monitoring the documents that come through the medical coding software, you’ll face fewer costly coding errors.
- Financial reporting will also improve thanks to the high-quality medical billing software most medical billing companies use.
Cons
- Your practice may feel like you have two billing teams and leadership may need justification as to why you have so many people handling your billing.
- If the billing/RCM vendor doesn’t communicate well, your practice could be missing out on important RCM information.
- Some practices may find the hybrid approach is more expensive than the in-house or outsourced approaches.
In-House, Outsourced or Hybrid: Find What Works for Your Team
Whether to have in-house or outsourced medical billing and coding is an important decision. Each option has its advantages and disadvantages. But using a revenue cycle management platform with an in-house team gives you efficiency and accuracy to help your business grow.
With Gentem, you can build this hybrid approach and boost your bottom line. We’ll improve your billing and revenue cycle efficiency, increase collections and develop accountability within your team. With Gentem’s robust analytics and AI-powered workflows, you can also identify and fix revenue leaks.
With a more efficient and profitable revenue cycle process, you’ll be able to spend more time growing your business and caring for patients. Book a demo today to learn how Gentem will help your business thrive.
