Category/ Medical Billing

Outsourced Medical Billing offers a Multitude of Benefits

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As more physicians outsource billing, demand for services is expected to rise by 168 percent

The demand for medical billing specialists is rising as hospitals, and other healthcare facilities struggle to deal with these reimbursement changes. The need for medical coding services has also increased because of the prevalence of electronic medical record (EMR) systems. According to the U.S. Bureau of Labor Statistics (BLS), employment in the medical- and health services industry will grow 13.8% by 2026, faster than the average for all occupations. Several recent reports have demonstrated that the medical billing outsourcing market is expected to multiply due to the growing demand. The number of in-house billings is expected to increase from $6.3 billion in 2015 to $16.9 billion by 2024.


The role of a medical-billing specialist hasn’t changed much over the years. Still, it has evolved in the sense that they now have more responsibility for submitting claims, collecting payments, and resolving errors. They must navigate a complex and ever-evolving regulatory environment that requires them to collect more information from providers and patients, adhere to new billing laws, and comply with government audits, among other things.


Many physicians will move from in-house medical billing to outsourced billing in the next decade. Here’s why it makes sense for you too.


Factors that contribute to an increase in demand

There have been many changes in the healthcare industry over the past few years. The Affordable Care Act and ICD-10 have made the task of billing and coding for physicians extremely difficult, especially since the introduction of the Affordable Care Act.


Medical billing outsourcing is becoming increasingly popular due to the following reasons:


Lack of in-house expertise; Revenue cycle management (RCM) has become more complex in recent years, requiring a higher level of expertise to achieve maximum reimbursement and optimal cash flow. A billing company’s staff likely processes thousands of claims across multiple specialties per month instead of in-house billers and coders handling hundreds. Taking advantage of this greater level of expertise can benefit medical practices.


Software that is no longer supported: To meet the latest industry demands, billing software has undergone a series of evolutions. Software upgrades can cost tens of thousands of dollars to stay compliant and maintain billing efficiency. If physicians don’t upgrade their software, they may find that their billing process is complex and inefficient due to outdated software.


Care for patients should take precedence: Physicians are under pressure to refocus on quality metrics due to changes like MACRA and a shift to value-based care to avoid penalties that may affect insurance reimbursements. Outsourced billing allows physicians to focus on patient care without having to worry about their billing as well. The billing company will be responsible for handling all incoming billing questions, so front office staff will also benefit from fewer calls.


Revenues increased as overhead costs declined: It is common for medical practices to have a fixed cost associated with in-house medical billing. Independent practices need to pay their staffing, and IT costs regardless of how much revenue comes in. It is possible to eliminate a portion of these expenses if you outsource your billing, shifting them to variable costs that depend on the number of accepted claims and reimbursements. Outsourcing provides significant revenue growth to medical practices with large claim volumes, partly because 20% of claims are not processed correctly by payers, resulting in underpayments and no payments. When practices outsource, they can enjoy significant cash flow and revenue improvements.


Why outsourcing is a good idea

It can be challenging to determine whether to outsource your practice’s medical billing. Yet, there is a point when it becomes too lucrative not to pursue it.


Switching to a third-party billing system can be intimidating and daunting, especially for physicians who have done billing in-house. Outsourcing billing can be a smooth transition – far from as intimidating as most people think.


However, not all billing companies are the same. Don’t settle if you have had an unpleasant billing experience. Consider working with a billing company that understands your needs, responds quickly, and has a track record of maximizing reimbursements.


As for pricing and budgets, they should be discussed, but the most important thing is considering the long-term. It’s not a good deal to pay less to a company whose collections are lower.


Choose one that charges a higher fee and has proven recovery rates when choosing a recovery company. As a result, you will not only cover the higher fees, but you’ll also have more money in your pocket.


Physicians can now hire staff to do follow-up work and pursue even more of their practice’s revenue with improved cash flow.


Think about Scribe Align Medical Billing

We can assist you if you are interested in outsourcing your practice’s medical billing. Our billing specialists understand the complexities of revenue cycle management and the critical role of accurate billing processes in ensuring practice profitability. Offering a full range of medical billing services fit for any practice size, we have a proven track record of reliability and effectiveness.

Differences between Physician Billing and Hospital Billing

Physician Billing vs. Hospital Billing: Understanding the Key Differences


Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.


With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, its based on the pricier reimbursement model, where the hospital charges the patients insurance plan for the services required and received.


Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.


To highlight the key differences between physician and hospital billing, lets find out how they are used in both cases.


Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
•    Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments. 
To make sure that the organizations overall financial and operational goals are met, people who work in medical billing and coding need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical offices billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly. 
The organizations ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
•    Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
•    All outpatient and inpatient services will be billed based on the patients insurance policy, so its important to check.
•    It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both billing and coding procedures. Healthcare professionals offices and hospitals employ medical billing and coding teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. Scribe Align makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like Scribe Align, you can focus on the doctors practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

•    The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
•    A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
•    An institutions configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
•    A physicians billing is similar to a hospitals billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
•    The hospitals appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.


Billing for Physicians and Hospitals: how to increase revenue?

•    Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
•    Keeping track of unbilled and unmissed claims and services becomes the physician billers priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
•    Outsourcing healthcare billing and coding services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
•    The hospital billing process is quite different from physician billing. A hospital or institutions billing function includes collection and billing.
•    As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.

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