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.
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.
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.