Top Seven Reasons Why Outsourcing Your Coding Is Profitable Than Doing it Internal

Internal team handling everything in RCM

Relinquishing control over the billing process and reluctance to entrust an external agency with the cash flow were two major reasons why medical coding and billing was not outsourced in the past. However, in the recent times, there has been a marked difference in how outsourcing decisions are made by practice owners & healthcare managers. While cash flow continues to be the primary reason for outsourcing, there are a number of other factors like higher value write-offs and lost claims that influence such decision.

Top Seven Reasons Why Outsourcing

Increasing business challenges in RCM

For provider organizations, spiraling expenses for maintaining an internal team of RCM experts is a big concern. Salary of the coding and billing team members can vary from fifty to sixty thousand dollars an year and that’s not the only expense. Additional expenses like health insurance, retirement benefits and paid time off needs to be honored too. These costs, when added to other statutory expenses like employer-paid taxes and disability coverage can come nearly thirty to forty percent of a coder’s salary. Lack of adequate certified medical coders have caused an increase in the coder salary due to the demand-supply gap making the hiring situation challenging.

An ideal Revenue Cycle Management team needs skilled professionals over and above experienced coders and billers. These roles include Certified Clinical Documentation Intelligence Expert, Certified Professional Medical Auditor etc. to manage quality and compliance. For each professional the annual salary can be as high as sixty five thousand dollars.

When cost allocations for computers, software licenses, employee hiring and training, office space and supplies etc. are all added up, the total yearly outflow becomes very high.

RCM – a business process that demands special attention

Revenue Cycle Management is a process that involves many independent yet connected functions. Broadly we can classify them into three buckets

  • Routine tasks such as charge entry, coding and claim submissions

  • Follow-ups and corrective actions such as claim resubmissions and tracking

  • Solving issues that need higher skills and expert decision making before a resolution is arrived

Most organizations do not have separate teams for handling routine functions and follow-ups. Available team members’ multi-task for coding, claim submissions and follow-ups which is a happy situation. However when claim denials that needs to be rigorously followed-up mounts, internal team is left with no choice other than doing the best with the available time. Completing every task without causing staff burnout becomes an unreachable goal. Federal regulations aimed to improve quality of care are being frequently changed in the last few years. Not coding as per latest regulations attracts hefty fines. Making sure that the coding and billing team is following the latest rules and proper protocol required by each payer is a full-time job now.

How to ensure a healthy bottom-line for Revenue Cycle Management?

A steady cash flow is important for a healthy bottom line of any business. Service disruptions during employee vacations and sick days cause billing interruptions leading to major issues with reimbursements and cash flow. Yet another area that often gets impacted is upward communication and status updates on rejected claims. Lack of timely managerial intervention often results in unappealed claim denials. This eventually leads to write-offs and lost revenue. Instances of ignored encounter forms and discarded superbills are also reported as outcomes of staffing challenges.

Is outsourcing Revenue Cycle Management (RCM) good?

In an outsourced scenario, the provider organization is relieved of all these operational challenges and associated expenses. With patient-centric, value-based care becoming the de-facto care delivery model, patient’s experiences regarding billing issues before and after their treatment gains importance. Getting a courteous and professional assistance for their billing questions is guaranteed with a professional agency handling it and this improves patient satisfaction.

To sum it up, even though steady cash flow remains the primary motivation for healthcare organizations to engage professional RCM companies, all the other interconnected factors that we discussed are also driving this shift.

Click here to watch the video

Are you looking for expert advice in RCM? Call us at 855-422-8747 or email to talk to professional today.

Acusis LLC @ 2019