The medical billing outsourcing sector in the healthcare industry across the United States has been rapidly growing, particularly in the last two decades, due to technological innovations in health tech. Currently standing at a market size of USD 3.73 billion in 2022, the market is projected to reach around USD 12.48 billion by 2032, showcasing a robust compound annual growth rate (CAGR) of 12.9% from 2023 to 2032. This article will delve into the key components, services, and end-user segments that shape the industry and explore the factors contributing to its growth, potential challenges, and future opportunities.

Market Overview:

Medical billing, practice management, or revenue cycle management (RCM) outsourcing has become a pivotal process for healthcare facilities to streamline insurance reimbursement and financial operations. Regarding software capabilities, outsourcing medical billing involves outsourcing billing tasks to third-party software programs, enhancing efficiency, reducing administrative workload, and ensuring proper payment for services rendered. It also involves human interaction to ensure claims are audited before submission, follow-up on claims, denial management, and overseeing the entire process to ensure reimbursement from insurance carriers and patients. The U.S. Medical Billing Outsourcing Market has witnessed substantial growth, driven by rising online billing platforms, government support, and the availability of efficient revenue cycle management solutions that support the healthcare industry’s focus on patient care and innovation.

Key Components Driving Growth:

  1. Outsourcing Dominance:

    • The outsourced segment has emerged as a key player, capturing a significant market share. Outsourcing provides a cost-effective and transparent alternative to in-house medical billing workflows, increasing healthcare operational efficiency and reducing administrative burdens.
  2. Front-End Services Leading the Way:

    • The patient onboarding process, including patient appointment scheduling, answering pre-registration questions, registering patients for qualified healthcare professionals, verifying insurance eligibility, insurance benefits verification, and pre-approval or prior authorization, involves a sophisticated layer between patient check-in and receiving services. All these steps are essential in the medical billing process to ensure the efficient management of the patient intake process, improve the patient experience, and achieve quicker reimbursement from insurance carriers without hurdles.
  3. Hospitals at the Forefront:

    • Larger medical groups, such as hospitals, contribute the largest revenue share, around 45.50% in 2022. The increasing complexity of billing and reimbursement procedures in larger healthcare organizations has prompted healthcare systems to adopt intuitive RCM services, minimizing errors and ensuring cost-effective solutions, creating a need for healthcare EDI and Software vendors to sell their services, resulting in more economic activity in the healthcare market.

Market Dynamics:

Drivers:

  • Government Support: Increasing government funding and programs in the past and current have propelled market growth, with initiatives like cloud-based EHR, EMR, Practice Management, and Medical Billing software facilitating comprehensive Revenue Cycle Management (RCM) capabilities.
  • Automation Technology: The surge in automation technology, particularly Robotic Process Automation (RPA) tools and the use of Artificial Intelligence (AI), has accelerated the processing of medical billing data, providing quick and accurate results by reducing errors and improving efficiency.

Restraints:

  • Lack of Trained Professionals: The shortage of trained healthcare professionals challenges market growth, emphasizing the need for experienced billing providers.
  • Lack of Free EHR: There has been a time when small practices, unable to afford thousands of dollars annually, were given the option to use Free EHR. However, all the free options have either not been innovated over time or have been sold out to corporate companies that now charge providers to use Free Electronic Health Record Systems. This also limits healthcare providers’ ability to innovate and focus on other areas.

Opportunities:

  • Innovative Techniques: Ongoing research and development efforts and increasing investments in R&D present opportunities for the industry to leverage new technologies and advanced resources.

COVID-19 Impact:

The COVID-19 pandemic has positively impacted the growth of the medical billing outsourcing industry due to laboratory services’ intention to help fight the Covid, and that led Medical Billing Outsourcing Companies to step in and offer Medical Billing Services. The accelerated adoption of digital technologies in healthcare, driven by the pandemic, has created new opportunities. The emphasis on building an effective digital health infrastructure and increased consumer interest in online bill payments has fueled the demand for medical billing outsourcing.

Future Outlook:

As we look ahead, the U.S. Medical Billing Outsourcing Market is poised for significant growth. The industry is expected to witness technological advancements, increased focus on regulatory compliance, and a growing need for cost-effective and efficient processes.

Conclusion:

In conclusion, the U.S. Medical Billing Outsourcing Market presents a promising landscape with substantial growth potential. The increasing reliance on outsourcing, technological advancements, and a supportive regulatory environment shape the industry’s trajectory. As healthcare providers seek more efficient and cost-effective solutions, the medical billing sector is positioned to play a crucial role in shaping the future of healthcare administration.

 

Overview of Behavioral and Mental Health Billing Services Companies and How It Can Improve Mental Health Clinics Revenues and Collections

iCareBilling (An American Medical billing company) – is a Complete Behavioral Health Billing Services Provider that provides Medical Billing Services to Mental Health Clinics, Behavioral Health Clinics and Hospitals, Medical Clinics, and Physicians Practices across the United States. If you are looking for Mental Health or Behavioral Health Billing Services Companies, you are at the right place. iCareBilling provides Medical Billing Services to numerous Mental Health and Behavioral Health providers so they can focus on patient care. By working with iCareBilling, your Behavioral Health practice will improve revenue and collection, which would help you improve patient care standards at your mental health clinic.

 

Introduction

At iCareBilling, we believe that anyone can make a difference. We believe in the power of healthcare to transform lives, and we are committed to helping medical clinics do just that. Our medical billing and consulting services for behavioral health practices are designed to help you optimize your mental health business so it can grow and thrive—so you can make the most of your staff, your patients, and your work.

 

We offer a wide range of services to meet your needs:

  • Medical Billing Services for Behavioral Health Medicare Patients
  • Medical Billing for Medicaid and Medicaid Managed Care Organizations (MCOs) for Mental Health Patients
  • Mental Health Insurance Claims Processing Services
  • RCM Services Integrated with Behavioral Health Medical Billing Software

 

Our team of medical billing experts is here to help you make informed decisions about your mental health practices on how best to run your behavioral health clinic or practice and improve medical billing indicators. We guide healthcare professionals to adopt the most effective behavioral health billing and RCM Services workflow on everything from pre-submission claims audit, claims electronic and paper submissions, follow-up, and payment posting for a behavioral health claim to resolve your medical billing and financial management issues like receivables management and healthcare EDI and software vendor management.

What Are Behavioral Health Medical Billing Companies?

Medical Billing Companies that provide Medical Billing, Practice Management, and Healthcare RCM Services to behavioral health or mental health care services providers are called Behavioral or General Healthcare Billing Services. Medical Billing is an integral part of the healthcare industry and helps medical facilities bill their patient’s insurance companies for medical or behavioral health services. Medical billing companies also provide RCM Consulting Services, which can be used to improve revenue and workflow to ensure that the systems used by your medical facility are up to date-and functioning correctly.

 

Medical billing companies help you deal with several different issues, including:

  • Improving Insurance Collections at Healthcare Practices
  • Reducing Claim Denials and Improving First Through Pass Rate by Submitting Clean Claims
  • Sending Correct Patient Statements for Patient Collections
  • Better Denial and Claims Management
  • Dispute Resolution on Claim Denials with Insurance Companies

 

iCareBilling Delivers the Best Medical Billing Services and is often Nominated as Top Ranked Medical Billing Company in the United States. iCareBilling Provides Specialty Focused Medical Billing Services such as Behavioral Healthcare Billing to Mental Health Clinics and Mental Healthcare Services Providers throughout the U.S.

 

The company delivers the best behavioral health medical billing services among all medical billing companies in the U.S. It provides behavioral health medical billing services to mental health service providers to suit their needs in the healthcare industry.

 

We have provided our clients with high-quality behavioral health practice management services with our staff’s combined 20 years of experience. Our staff is highly trained and knowledgeable about the industry. We understand what you need to succeed in your mental health clinic to make an impact at a more significant level. This can’t be done without a top-ranked behavioral health medical billing company standing by your side.

 

We can customize our solutions based on the unique needs of each client. This includes things like:

  • Providing accurate estimates so there are no surprises when it comes time to receive the reimbursement of your mental health claim.
  • Optimizing the Practice Management and EHR Software to Bill Behavioral Health Claims with Minimum to Zero Denials
  • Guiding how to improve efficiency within your organization so that you can get back on track as quickly as possible
  • Develop relationships with physicians and other healthcare professionals who will refer patients within your network, allowing us to reach more patients than ever!

 

iCareBilling provides Behavioral Healthcare Billing Services compatible with all Behavioral Health Electronic Health Records (EHRs), Mental Health Electronic Medical Records (EMRs), and Behavioral Health EHR Based Billing Software throughout the United States.

 

For Cost-effective Medical Billing Solution, contact iCareBilling Medical Billing Companies Now.

At iCareBilling, we understand that your time is valuable and that you have a lot of other things to do besides managing the care of your patients. That’s why we offer our clients the most accurate, efficient, and affordable mental health billing services in the United States. We work with you to develop a customized workflow management plan that meets your needs, whether for mental health practices, behavioral health clinics, or any other specialty of the healthcare business. Our medical billers are RCM Experts who are available behind the iCareBilling to answer any questions about how we can help you improve your bottom line.

 

How iCareBilling Can Help Behavioral Health Practices in Medical Billing?

iCareBilling provides Specialty Focused Medical Billing Services, and Behavioral Health is one of many specialties iCareBilling staff is trained to handle the tasks to improve your mental health practice revenues and collections. We offer medical billing services for medical clinics, behavioral health practices, and mental healthcare providers, and our services include;

 

 

iCareBilling Provides Medical Billing Consulting Services to Mental Health Practices and Behavioral Health Clinics to Improve Efficiency and Effectiveness at Practices Level throughout the U.S.

 

Behavioral Healthcare Practice Management and RCM Consulting Services for Mental Health Clinics

iCareBilling provides customized medical billing solutions integrated with all leading EHRs / EMRs, Practice Management, and Medical Billing Software to deliver unmatched Billing Services to Behavioral Health Providers throughout the United States to help them operate effectively. Our team of medical billing professionals understands the process of managing your healthcare practices’ patient claims. It can effectively manage all the RCM tasks to reduce costs and improve revenue while ensuring that you have enough time to focus on providing the best care. We offer a variety of services to fit your needs.

 

For cost-effective behavioral health EHR based billing services, contact iCareBilling today.

 

Our team is always willing to help you with the following:

Medical Billing Services

Practice Management Services

Healthcare RCM Services

Credentialing Services

iCareBilling is a Medical Billing Company that offers RCM Solutions flexible with all EHR (Electronic Health Record), EMR (Electronic Medical Record), Practice Management, and Medical Billing Software for small practices, independent healthcare providers, medical clinics, medium and large size medical group, and hospitals throughout the United States. iCareBilling, as a medical billing services for small practices, has been featured on Forbes under Best E-Prescribing Companies for 2022 category and has achieved the Top Medical Billing Companies awards in the U.S. healthcare industry.

 

Introduction

We at iCareBilling provide a complete range of healthcare and IT Support Services for your healthcare practice and meet medical billing needs. We offer a wide range of products and services to help you get the most out of your business. Our goal is to make sure that you can take care of all your patients well enough while still making sure that they have access to the best possible healthcare care services you’re your healthcare facility.

 

We understand that running a medical business can be challenging, no matter if you have a small medical practice, a large medical group, or a hospital. It’s even more challenging when trying to manage everything independently on your own without the help of industry experts. That’s why we offer our medical billing services and related business services to the healthcare industry at an affordable price so that you don’t have to worry about your revenues and collections. This way, you keep striving to make your customers (patients) happy! Our team has years of experience in the medical billing, practice management, and RCM industry, so they know precisely what steps to take for us to be able to help you get the most out of your business with minimal hassle or stress on either side.

 

What is a Medical Billing Company’s Business Model, and How Does it Help Small Practices?

Companies that offer medical billing services, practice management, or healthcare RCM solutions together with related business services such as Credentialing Services, Provider Enrollment, and Healthcare Consulting to offer the best EHR (electronic health record), EMR (electronic medical record), Practice Management Software, or a Medical Billing Software to help you automate your clinical and non-clinical workflow as well as manage your revenues and collections for your healthcare businesses are called Medical Billing Companies. The revenue cycle management process includes everything from appointment scheduling to coding and collecting payments from insurance companies and patients to ensure that the healthcare providers and healthcare businesses are getting paid in a timely fashion.

 

Medical Billing Companies can also help your medical practice, medical group, hospital or other healthcare businesses with compliance issues such as HIPAA compliance regulations and SOPs. Many medical practices also use these companies for practice management tasks such as scheduling appointments or communicating with patients about their insurance benefits, and ultimately it’s the medical billing companies who ensure that practices are using HIPAA Compliant tools to comply with all regulations.

 

Benefits of Using an Outsourced Medical Billing Services

Using a medical billing and RCM company will help you reduce the time and effort required to manage the billing process, free up staff time for patient care, reduce the risk of errors, increase revenue and improve cash flow by increasing the collection from insurance companies and patients.

 

Additionally, it can improve patient satisfaction with services rendered without worrying about being less paid or underpaid by insurance companies. A reputable medical billing and RCM company will also ensure that all bills are paid on time or early in case they have been overpaid or underpaid by your insurance carrier (this could lead to problems down the road).

 

It’s not just about money – it’s also about reputation and the patient care!

 

Billing companies support Revenue Cycle Management integrations and HIPAA Compliance.

Medical Billing companies fully support integrating different EHR (electronic health record) systems with their revenue cycle management services and have strict policies and procedures to comply with HIPAA and Compliance requirements. Revenue cycle management refers to managing all aspects of insurance reimbursements for your practice, from claims submission through payment, with the help of integrated EHR to facilitate the patient onboarding processes and keeping the documentation of clinical notes per industry standards.

Certain Healthcare RCM companies help you with practice management, including patient account setup (including EHR integration), appointment scheduling, engagement letters, and more.

 

iCareBilling helps your practice gain access to new markets.

By partnering with a medical billing company like iCareBilling, you can increase the number of patients who are covered by any health plan, and their healthcare costs are covered. The more people who can afford healthcare services, the more it will improve your practice revenue for your practice—and that means making more profit!

 

In addition to increasing revenue by attracting new health-insured patients, medical billing companies also help connect providers with Enrollment and credentialing services with insurance carriers (or payers) you may not have heard of them before. This is critical to stay competitive in today’s healthcare industry, where there is so much competition from other practices looking for new clients. Your practice should be able to accept new patients to keep growing your client base.

 

Focus on what you do best.

When you hire a medical billing company to handle your administrative tasks, they can focus on the things that matter most. You can trust them with your practice’s day-to-day operations and leave them alone to do what they do best: manage the administrative tasks associated with billing and compliance.

 

Medical Billing Companies Staff Members Are Experts in Their Fields.

When it comes time for you or one of your staff members to handle some of these tasks yourself, it’s often difficult because so many details are involved. The more complex an area is, the more difficult it becomes for even seasoned professionals like yourself or staff members—not just because no one wants their job taken away!

 

Medical Billers working in a professional medical billing company always have adequate training to ensure they can deliver the best medical billing services to physicians and healthcare providers to improve revenue cycle management and practice management indicators. Done till here.

 

Why iCareBilling is the Right Choice for Medical Billing Needs?

At iCareBilling, we take pride in providing our clients with the highest quality of care. We understand that working in-house on your medical claims to keep up with revenue targets can be stressful and time-consuming, but we believe that we can provide you with the service with ease of access so you can focus on patient care.

 

We work hard to ensure you have access to the best medical billing services available. Our company offers a wide range of services for all types of businesses, including:

 

  • Medical Billing
  • Practice Management
  • RCM – Revenue Cycle Management
  • Insurance Enrollment and Credentialing

 

Frequently Asked Questions

What is iCareBilling?

iCareBilling is an American healthcare information technology company that provides Medical Billing, Practice Management, Healthcare RCM (Revenue Cycle Management), Provider Enrollment & Credentialing, and Web Design Services to independent healthcare practices, hospitals, and large medical groups throughout the United States. The company’s unique Healthcare RCM Services are compatible with all Healthcare EDI & Software Vendors, including any EHR/EMR System, Practice Management, or Medical Billing Software.

 

What’s the difference between iCareBilling and other medical billing services?

Our team of experts has provided affordable and effective medical billing services with a combined experience of more than 20 years. We know each client has specific needs, so we work with you one-on-one to find the best solution for your particular situation. We can also help with claims processing, HIPAA compliance, and more!

How do I get started with iCareBilling?

It’s easy! Visit our website Contact Us page and fill out our online form with all your information, and we will get back to you shortly.

 

At iCareBilling, we aim to resolve medical billing issues and improve efficiency and workflow at healthcare practices. We deliver Medical Billing, Practice Management, and Healthcare RCM Services to individual doctors, group practices, and hospitals throughout the United States. We have a team of experts to handle any EHR, EMR System, or Practice Management/Medical Billing Software to let healthcare professionals enjoy easy access to Reports, Better Denial Management, and Daily Clean Claims Submission with Maximum Accuracy.

 

We are thrilled to announce that Clutch has recognized iCareBilling among the 2022 leaders in the BPO industry and one of the Top 1000 Global Companies for 2022. Being a Best Medical Billing Software and Services Provider, it’s proud for iCareBilling to be listed among the Global 1000 companies. Earlier this year iCareBilling was also listed on Forbes under Best E-Prescribing Software for 2022 as well. For context to this Clutch Global 1000 award, Clutch is a B2B resource that connects businesses with the best-fit agencies or consultants they need to tackle their next big business challenge.

 

These reviews form the basis of Clutch’s research efforts in deciding the best companies in every industry in every country. However, the Global 1000 takes this concept a step further by condensing all of these lists and building an even more exclusive group of the best 1000 companies in the world. Being a Medical Billing Company listed in the Global 1000 list is an outstanding achievement, and we couldn’t make this possible without our client’s and employee’s dedication. 

 

“We really value The Manifest and Clutch awards and appreciate the very transparent criteria, even if a company is not on a paid sponsorship but adds value to the marketplace, the company is being rewarded appropriately, and we love that.” – IK Sayyid, Representative at iCareBilling

 

We’re delighted to receive this outstanding award and look forward to helping even more companies expand their businesses. We genuinely believe that our client’s satisfaction is one of our essential benchmarks for success. To those clients that left us a review, we genuinely appreciate all the positive reviews and feedbacks that help to rank iCareBilling as Top Ranked Medical Billing Company in the U.S. Here’s what they have to say about working with us:

 

“Their team has been very accessible through phone calls. iCareBilling has excellent project management — they’ve made sure not to miss a single deadline. “ – Dr. Saamer Siddiqi, Owner, LiveMed

 

Schedule a consultation call to discuss the solutions for your Medical Billing, Practice Management, Healthcare RCM, Provider Enrollment & Credentialing, and Web Design needs.

Common Medical Billing Mistakes and Healthcare RCM Solutions to Improve Revenue and Collections

 

Providing medical care with the highest satisfaction of patients is the ultimate goal for a healthcare business; undoubtedly, reliable medical billing service plays a vital role in delivering quality care and avoiding common medical billing mistakes. Whether you have a physical therapy practice, internal medicine or family practice, or any other specialty, the most important thing is to have smooth RCM operations to ensure constant cash flow. Medical billing and denial management problems can slow you down, increasing pressure on your finances. Utilizing medical billing management companies decreases the possibility of encountering billing complications and effectively improves healthcare business offices and clinical workflow management efficiency. Medical Credentialing Service is the one fundamental service that medical billing companies offer to start things with new practices.

The fundamental problem in the healthcare business is collecting due balances from patients in a certain way it could improve the cash flow for healthcare entities. If you have an effective medical billing services company on board, you can automate the process of generating and tracking the due balances, sending reminders to the patient with a specific interval, and allowing the patients to pay the bills with ease of access. Due to the complex healthcare system, there are challenges, but a good RCM workflow can automate the payment collection process to achieve higher results.

The Seven Most Common Issues / Problems with In-House Medical Billing at Physician’s Offices and How to Fix Them:

The following is a list of seven common problems if you have an in-house medical billing department or planning to have one, along with the remedies to those problems!

1. An Absence of Necessary Information

It is common for medical billers at physicians’ offices to make the mistake of leaving important information off of a claim, such as patient’s demographics information, insurance information, and in case of auto accident claim accident/injury date and other worker compensation details. Even if the patient’s insurance has the benefits coverage and the claim can be processed towards reimbursement in the first attempt, not having enough information will result in more claim denials.

During the intake process, please check for missing or blank information. It is your best opportunity to spot omissions before they lead to a time-consuming procedure of denial and resubmission or contacting the patient for missing information.

2. Incorrect Identification Information Regarding the Patient

When entering patient information into your medical billing software or an EHR Software, you risk making claims reimbursement more difficult even if there are minor errors. It is common amongst clinicians that they face claims denials from insurance companies due to minor errors. If the denial management is not adequately set up, that can cause problems in getting the claims paid. Such mistakes as misspelling a patient’s name or changing their birth date can result in considerable losses in revenue and collection.

There are two approaches to taking care of this problem. The patient information should be taken by the intake department if that’s working separately from Medical Billing Staff working in-house. This allows them not to multi-task and focus on taking the most accurate information. The second step is to find a medical billing company that can help to perform a pre-submission claim audit to ensure that claims are going with maximum accuracy. Medical Billing Companies have software that can check the eligibility before generating the claims EDI files for submission. Their internal auditing process ensures that a validated clean claim is submitted to ensure timely reimbursement.

Imagine that before patients come in for their first evaluation visit, you ask them to enter their information, validate it with you, and later call them back, asking to verify the information as you have received a denial on the claim submitted to the insurance company. Healthcare providers must have a streamlined workflow to take the most accurate info from patients, which could result in faster reimbursement from insurance and patients.

3. Healthcare Claim Coding and Clinical Workflow Issues

Incorrect medical claims coding is one of the most common mistakes made by healthcare professionals and one of the most time-consuming mistakes. Claims may be incorrectly coded for a variety of reasons, including the following:

  • Utilization of expired Codes (CPT Codes and ICD-10 Diagnosis Codes)
  • Bundled Services Billed Without Modifier
  • Ignoring the Mutually Exclusive Edits (PTP Coding Edits)
  • Overcharging and Under Billing of Services
  • Incompatible CPT or ICD-10 Diagnosis Codes
  • Expired/Absolute CPT and ICD-10 DX Codes

The solution to these problems is to have a Top-Rated Medical Billing Company standing by your side that has all the automation and procedures in place to ensure that they don’t drop any ball while validating the claim and preparing it for submission the final claim. Most Medical Billing Companies ensure that the CPT/ICD-10 Diagnosis Codes are up to date and make consistency between the services provided. It helps healthcare professionals to maintain consistent healthcare coding standards. When you use Medical Billing Software or an EHR – Electronic Health Record, you can incorporate only the codes that are compatible with your specialty and the services you have selected to provide. This reduces human error and alerts the clinical staff when a selected service doesn’t qualify to be compatible with healthcare provider settings. The result is spending less time on Charting in EHR Software and focusing more on delivering quality care to your patients who needed the most.

4. Claims Submission More than Once

When dealing with different healthcare providers’ staff members, we have observed that they tend to resubmit the claim more than once, thinking that it will help to get the claim paid without focusing on why it has never been paid in the first place. There could be other mistakes leading to this one that might include patient billing as an option, as they might see that patient’s coverage has some issues. Unnecessary claim submission to insurance companies will result in multiple denials. Later, when in-house medical billing teams start to follow up, it becomes more challenging to determine which claim is the original and which should be rectified. If patient billing is also involved, which will reduce patient satisfaction, and healthcare offices end up getting bad reviews, this can ruin the whole healthcare business reputation.

The answer to such a problem lies in the automation of the medical billing process that is being handled by most healthcare RCM Solutions Providers to ensure that healthcare professionals get paid for the services provided. Medical Billing Companies have a process to detect duplicate submissions, and even rules can be enabled in EHR and RCM Software to ensure if anyone attempts to create a second charge for the same services and treatments, that must generate an alert. Medical Billing Staff training can also help to reduce such mistakes when managing an in-house medical billing team. Continuous training of the medical billing team is essential to keep up with the healthcare industry changes.

5. Insufficient Documentation

To process claims and make payments, all healthcare providers, physicians, and clinical staff members must maintain electronic copies of medical documentation. If not using an EHR, they must maintain the paper trail. Even though CMS has encouraged healthcare providers to use the EHR and issued significant incentives in the last decade to help in the adoption of EHR, some providers still use paper charting and have not evolved their process to the EHR-centric medical documentation record system or EMR – Electronic Medical Record systems. If you do not maintain the medical documentation, that can cause problems such as when insurance decides to hold the claim requesting medical documentation or later they may reject if they do not receive the medical docs in a certain period. Healthcare providers may face other challenges, such as CMS audits the practice to ensure they comply with all HIPAA, HITECH, and other regulatory requirements. To meet all the healthcare standards, healthcare providers must ensure that they maintain sufficient medical documentation to prove the necessity of the claim and comply with all healthcare regulatory laws and requirements.

Your medical billing services staff enables you to spend more time charting and maintaining the healthcare laws so you can do your job accurately. The expert medical billers at medical billing companies focus submit a clean claim and getting you paid as quickly as possible.

6. Change in Patient Insurance Coverage Due to Change in Employment

Many factors can affect a patient’s insurance coverage, including a change in employment. If you do not have an EHR System that could track the patient’s employment history, you would not be able to find a clue why claims are not getting paid suddenly, whereas this was not the case before. In addition, caps may be placed on the total number of visits or treatments paid by the employer-sponsored healthcare plan during their employment period. If these caps are exceeded, the patient will be liable for covering the additional costs.

If the healthcare claim is sent to insurance and denied, which requires the patient to update the COB – Coordination of Benefits, you must inform the patient about it. If claims are still being submitted and resubmitted incorrectly, it could result in costly delays and make it more challenging to recover from the patient health plan. Since you can’t identify the new insurance carrier, you won’t be able to get the claim paid. At each visit, it is essential to confirm that the patient is covered by their insurance plan. The healthcare provider intake department is responsible for confirming the patient’s insurance coverage when scheduling the appointment while ensuring their benefits have not expired.

Outsourcing medical billing to a professional healthcare RCM company with well-rounded denial management services can help you identify such claims denials so you can coordinate with your patients to see if they have any other insurance that can cover the cost or if they are willing to pay the cost out of their pocket.

7. The lack of Either a Referral or Prior Authorization

Patients enrolled in specific medical plans must receive a healthcare service from their PCP or Primary Care Physician. If patients need to visit any other specialty healthcare professional or a specialist for further diagnosis and treatment, they must have prior approval from the patient’s insurance; that’s called Prior Authorization. It’s common for healthcare providers to refer patients to other healthcare specialties they do not deal with so the patients can get the appropriate services.

But if the prior authorization has not been obtained by the insurance company, meaning approval has not been taken by the patient’s healthcare carrier before providing the services, that can also result in denials, and in a few cases, you even can’t request a retroactive authorization that allows you to request the prior authorization in the back date for the services has already been provided. To prevent this problem, you will need to confirm with the patient or with the insurance plan which type of services are covered in their plan and if they have out-of-network benefits in case of an HMO plan or they have a PPO plan that allows the patient to visit the wide range of healthcare providers. You will also need to ensure that your staff is aware of the constraints and regulations, and restrictions imposed by the healthcare insurance carrier so they can comply. If the patient does not have a referral or prior authorization, you might try to obtain one through collaborative efforts with the patient’s insurance carrier before providing the services and even before submitting the claim.

 

Paying attention to detail is required to have an effective medical billing workflow at healthcare offices. Taking care of these mistakes can help you guarantee that your healthcare claims are accurate to get reimbursement and that your patients are receiving the appropriate level of care. Automating these medical billing processes can also help achieve constant cash flow for your practice and fewer denials from insurance companies.

All healthcare professionals understand the importance of outsourced medical billing services. At some point, they have to hire an Outsourced Medical Billing Company that is more innovative and effective. Since there is still a significant amount of risk involved and many things can go wrong, healthcare professionals can’t afford to face such a significant loss.

 

Outsourced Medical Billing Services Company

Managing a healthcare practice without having the right team standing by your side is much more difficult. If you have decided to have an in-house medical billing team, constant training and improvement of the Healthcare RCM Workflow are essential. Your best, in this case, can be to hire a Professional Medical Billing Company and outsource all of your Revenue Cycle Management related tasks to the Outsourced Healthcare RCM Company. This will allow you to focus on your business workflow and make an improvement every next day.

 

You would like to Outsource Medical Billing Services? Contact Us Today to schedule an appointment with our Healthcare RCM Consultant and see how iCareBilling can help you to improve your revenues and collections.

 

What is iCareBilling

iCareBilling LLC is an American Healthcare IT Company that provides Medical Billing, Practice Management, and RCM Services to independent healthcare practices, small, medium, and large-sized medical groups, healthcare clinics, laboratories, telehealth practices, and hospitals throughout the United States.

How does a Medical Billing Company Impact Towards Healthcare Business Growth?

 

Medical billing and coding companies’ services are essential to robust growth in RCM – revenue cycle management in healthcare business settings. There are many factors a Medical Billing Company Effect on healthcare business growth, improved collections, and KPI indicators. This can be more effective and result-oriented when a top-rated medical billing services company is chosen. Generally, performing the tasks of insurance credentialing, medical billing and coding, is critical for ensuring compliance. Still, they are also essential for reducing the number of claims denied or rejected, which affects the revenue cycle management of healthcare business in the United States very badly. In today’s value-based healthcare environment, hospitals and other healthcare institutions are measured based on the quality of care provided. Even the slightest deviation in clinical documentation at the healthcare practice level can leave considerable gaps in the revenue stream and the delivery of quality care to the patients. This is because even the most minor deviation in documentation is based on the patient’s medical history that reflects on the claim. Clinical Documentation Improvement (CDI) will remain of paramount significance so long as your medical billing company continues to serve as the primary resource for small size medical practices, medical groups, and hospitals.

Claims Processing and Patient Billing Workflow

The efficiency of the people who manage the medical coding and billing processes significantly impacts the total cash flow that a medical practice generates. The provision of high-quality care to patients is the primary focus of all professionals working in the healthcare industry to ensure that the paperwork is completed in compliance with all regulatory requirements. On the other hand, increases in proportion to the number of patients generate more stress on the procedure being adopted to follow for the stability and continuity of healthy RCM workflow. However, as long as this paperwork perform accurately, you have no reason to be concerned about it. Effective medical billing and coding benefit patients, healthcare providers, and RCM solutions providers like medical billing companies. Having the right medical billing company standing by your side helps healthcare business owners and decision-makers responsible for delivering quality care. If you have a medical practice that has a system in place to identify the patient responsibilities accurately and automate the workflow to collect due balances from patients for finalized insurance claims, you can guarantee a consistent cash flow and revenue growth in healthcare practice, and that will increases the client satisfaction level significantly.

 

Medical Billing and RCM Key Performance Indicators for Healthcare RCM

Your ability to effectively identify and implement the KPIs (key performance indicators) is essential to determine your practice performance in achieving your goals. Medical billing companies generally have the KPIs being monitored by their employees to ensure lowering the number of claims that are denied and maintaining a healthy revenue cycle. When assessing key performance indicators (KPIs) in a value-based approach to healthcare, the efficiency of the medical billing companies matters because correct coding and documenting the process on the clinical side will only get benefits when expert medical billers are handling it. Two factors primarily determine these:

1.   Productivity in Coding:

The number of hours spent coding can be calculated by taking the entire records count and dividing that by hours spent by the clinical staff, such as Medical Directors or Directors of Nursing. What determines how efficient a process is is how little time it takes to do the most difficult tasks. Inpatient coding records should be completed at a rate of 24 per eight-hour paid workday as an example of an acceptable requirement for effective productivity in coding. Despite this, this metric will need to update due to additional coding tasks. The complexity of the management structure, case mixing, and other factors. The numbers can be improved if you have an EHR with a great SOAP Notes workflow designed based on your practice specialty and other needs.

2.   Accuracy in Coding: 

Since the healthcare organization is responsible for assigning coding levels, a policy document that evaluates how accurately the levels are coded is necessary. The official manuals and online coding tools can improve coding efficiency and serve as benchmarks. When using a Certified EHR, you will get the coding validation tool to ensure your procedure and diagnosis codes are compatible. Such EHR Systems also enable checking drug-to-drug and drug-to-disease allergies to ensure that no wrong medication is prescribed to the patient.

How Does Efficient Medical Billing and Coding Contribute to the Positive Aspects of Your Practice?

The following is a list of benefits that can be attributed to the preciseness and efficiency of the billing and coding process:

1. Having an Effective Medical Billing System reduces the number of Demands Placed On Physician And Their Support Staff :

The majority of those working in healthcare continuously undergo time sensitivity. Patient care consumes most of the staff’s available time during the day. If workers also have to make the claims ready for submission, check on rejections, follow up with insurance and perform payment posting tasks, their workload may become unmanageable. It is only a matter of time before a claim is filed, either with incorrect coding or with the correct one. Still, it takes more than time, such as hands-on experience, familiarization with insurance rules, and understanding the complex medical billing process, to get the claims finalized and paid by the insurance company. If industry experts do not handle the RCM process, this leads to denials, leading to a reduction in revenue. If you have an efficient medical billing company on board and working efficiently, there will be no delays in payment, and your employees will be free to concentrate more on the patients. The problems caused by unpaid claims and bad debts will no longer be an issue by having a top rated medical billing company working tirelessly for your success.

2. Avoidance of errors in medical billing that might have unfavorable repercussions in legal matters

When assigning a medical code to a particular treatment a provider supplies, a biller needs to pay careful attention to the particulars and look for the codes that most accurately describe the service delivered. When assigning a code to a medical operation, even the tiniest mistake might cause a delay in payment or even result in the denial of claims. Sometimes even such mistakes would result in sending clinical documents to the insurance companies to prove the necessity of the services delivered and filing a claim re-consideration, claim re-processing, or even filing appeals. Such billing and coding mistakes could potentially consider a criminal offense, and in some cases, insurance payers start investigating by having an audit of the healthcare practice. When deciding on a healthcare business opening, always choose a medical billing company that is efficient and accurate in case you don’t have an expert medical billing team to work for you in-house. You not only reduce the risk of legal ramifications but also eliminate the risk of any delays or denials instead of receiving compensation.

3. Assists in the Establishment of a Productive Procedure, Which Facilitates the Prompt Verification of Patients’ Eligibility:

An efficient workflow for the medical billing system will ensure that the patient’s eligibility information is checked well in advance. This will ensure that the claims are not denied, and that appropriate reimbursement will be received. This requires in-depth knowledge of insurance integration and usage of eligibility and coverage benefits verification. In the old days, the employees did the benefits verification manually. Still, nowadays, you can have medical billing software to check the patient’s eligibility and benefits verification automatically and instantly. Medical Billing Companies have the right tools in place that helps healthcare businesses to go easy on scheduling appointments, designing an easy intake process to collect patients’ data to ensure that biller has the most accurate information to bill the claims and get them paid in the first attempt.  To be efficient, you can be confident that you will top rated medical billing company on board, and you can utilize experienced medical billers to minimize the number of claim rejections whenever you submit them and get the required reimbursement more quickly.

 

4. Timely Payment of Claims and a Steady Flow of Cash to the Medical Practice:

When starting a medical practice, constant cash flow is vital to keep the business alive, and medical billing services for small practices can help you with that. The primary requirement for continuing medical practice is the provision of consistent financial resources to the organization. This is a possibility only if there are a few claims that deny. Claims that are filed for reimbursement must be accurate and comprehensive by having an efficient coding and billing procedure in place that ensures that these claims are being sent through a clearing house, get on file with insurance companies, get processed, finalized, and check is received in the healthcare provider’s bank account. This not only helps to ensure that claims pay in a timely and regular manner, but it also contributes to the overall health of the practice.

 

Need Help with Medical Billing Services?

If you are looking for a Healthcare RCM Solution that can help you improve your collections, and revenue, contact iCareBilling today by scheduling a call back and we will get back to you shortly.

 

Medical Billing Companies offer great tools in the healthcare industry which evolve and set new trends and standards to improve patient care. The relationship between medical billing and health information technology is vital and the usage of the latest tools and techniques, and medical practices can make significant improvements in overall patient care standards and it influenced the healthcare sector positively. 

With the use of Care Coordination and Telemedicine, all covered entities which include Medical Billing Service, and other relevant entities can help to support the overall infrastructure to allow healthcare professionals to serve the nation by presenting the slogan “Better Healthcare for All”. In the last decade, all the covered entities in the healthcare industry have moved from EDI V4010 to EDI V5010 and the implementation of ICD-10 in the last decade has made significant development to accommodate new technologies and procedures. 

This new technology is helping healthcare professionals to exchange information to improve patients’ health conditions with better clinical analysis and reporting. Telemedicine demonstrates different applications which can be used two ways via email, video call, wireless tools, and any other forms of communication technology and this is greatly helping to reduce the barriers between patient and doctor. Medical Billing Companies like iCareBilling offers their clients the best tools to accommodate their needs along with Medical Billing Services Here are the few benefits we all will be getting by using telemedicine tools in the healthcare industry.

  1. Extending care for remote areas
  2. Helping larger institutions to deliver better clinical care to their patients
  3. Better reimbursement and not a huge difference between the fee schedule of services rendered on-site vs remote patient monitoring 
  4. Close coordination with HIT for effective use of technology for better healthcare
  5. Using electronic tools which will help physicians to adopt EHR, and Web, Cloud-Based Practice Management Systems
  6. Ease of Access and reduce traveling cost
  7. Better Management of Healthcare by using Technology Adoption

Finding the perfect match in the list of Medical Billing Companies is hard, but with the right knowledge, you can identify the Best Medical Billing Company for healthcare services providers, hospitals, and group medical practices. While growing, you come to a point, where you need Outsourced Medical Billing Services to improve productivity and get some time off to focus on the core healthcare business.

However, every physician practice will not have the same needs. It’s very common to find similarities in other healthcare groups, but each practice has its own specific needs. When looking for medical billing companies, you need to find the right billing partner to meet your practice needs. Here are some key points to consider when shortlisting and making a final selection of an ideal Medical Billing Company that can meet your unique needs.

Flexible RCM / Medical Billing Service

If you are already using EHR / Practice Management Software, you have to look for such Medical Billing Companies that offer flexible medical billing services so you don’t need to switch your lovely EHR.

Medical Billing Software Dependency

If you are not using any EHR / Practice Management System and would like to move on to one with a new billing company then you have to look for a specialty-focused EHR along with a specialty-focused medical billing company. Every Medical Billing Software and EHR System is not designed for all types of specialties and you need an EHR & Billing System which has additional functionalities just more than just an appointment scheduling system.

Suitable Solution for ICD and CPT Coding on Claims

The medical billing service should have the solution to take your manual billing and coding details and put them together in a claim with proper identification of diagnosis information to the relevant procedures performed along with relevant modifiers to avoid claim necessity denials. This section has a dependency on the efficiency of the medical billing team and the medical billing software design which allows making this happens as expected. If a medical billing company lacks in this area, the majority of your claims will be either rejected by the clearinghouse or will be denied by the insurance company due to “inconsistent diagnosis code”, “invalid/missing modifier” or with denial reason “services provided doesn’t prove the necessity”.

Electronic Healthcare Claim EDI Processing

Once the encounters are uploaded for the billing team, these should be processed and sent to the insurance company electronically with EDI (Electronic Data Interchange) or via paper. An Experienced Medical Billing Service checks each insurance requirement and prepares the claim in accordance with a checklist to ensure the first time passing through all the checks to get the claim on file. When dealing with claims electronic submission, the selection of an EDI vendor is also important to make sure that the Medical Billing Company is using the efficient EDI Vendor to ensure claim submission processing.

Healthcare Claims Aging Follow-Ups

The task of medical billing and providing end-to-end revenue cycle management services is more than a data entry of patients’ demographics, claims, and submissions. The expert medical billing team has to look into the claim’s status after certain days of claim submission to ensure that claims sent to the insurance are on file and get the updated status. In case the sent claims are rejected or denied by the insurance payer, then it comes to the billing team’s efficiency to utilize their medical billing skills to get them paid by fixing the issues/errors on them.

Medical Billing Companies having a standard process of claims follow-up to get the claims paid is always being recommended by physicians as the number 1 choice for medical billing solutions.

Medical Billing Periodic Reporting

A perfect medical billing solution provider keeps its clients updated on payments through periodic reports. The more efficient a billing team is, the better they would keep the practice notified about the daily, weekly, and monthly status of the payments received from the payer. The physician medical billing services provider should also update the revenue earned in a certain period of time.

Medical Billing with Efficient Customer Service

A Good Medical Billing Company always invests in providing efficient customer service to their clients to answer their queries in the shortest possible time. If you are the person working on emails and do not prefer to go on calls due to a shortage of time, check the most responsive medical billing company process of handling client communication and always choose the one with the best response rate recommended by their clients.

If you need help in resolving your healthcare practice medical billing issues, please schedule a call back with our Medical Billing Expert to discuss the details. Our initial consultation is free.

If you are facing problems around cash flow in healthcare practices, you should reconsider checking the workflow at your medical practice to improve the medical billing and collections process. It is hard to keep up with healthcare changes and updates, but it can be done with the right medical billing processes in place which helps you to be more organized. Even though the medical billing process is not the one reason which needs to be improved but it is the most important one when considering improving Medical Practice Cashflow and Collections. Healthcare Denial Management has always been an important factor to consider while checking the Medical Billing and Collection Process.

Manage Cash Flow in Healthcare Industry

Medical Practice Collections depend on different factors and directly and indirectly impact the revenue of your practice. Outsourced Medical Billing Company can help you to streamline the workflow at your healthcare practice. It can play a vital role in maximizing revenue and collections. A Medical Billing Process that is aligned with your medical practice needs is vital to improving the key performance indicators and it can give a boost to your medical practice’s financial stability. Here are a few tips which can help you to improve your Medical Billing Process which will result in Improved Practice Collections.

Medical Practice Staff Training

Investing in human resource development has always been regarded as the most beneficial long-term investment. In healthcare practice, staff members must be trained to round all corners to ensure a consistent cash flow. Develop the standard operating procedures to provide guidelines on how to react and certain types of situations.

Research and Analysis on Denial Management in Healthcare

Help your medical billing team to learn the process of denial management in healthcare to ensure all the denied and rejected claims are being taken care of shortly. Any delay in acting on the denied claim would further reduce the chances to collect possible reimbursement.

Efficient Patient Billing Process

Due to not having an efficient medical billing company standing by your side along with not having an efficient collections process, you might end up having unpaid claims for patient balances. Help your front desk and billing team to bill the patient immediately after the services are provided. If they are self-pay patients and requested an itemized statement to release the payment. Delay inpatient billing would increase your healthcare practice’s account receivable volume.

Billing Efforts and Effective Practice Management System

It’s equally important to have an effective practice management system integrated with EHR System to achieve the required results. If the practice management system is not efficient, consider checking out a different solution to meet your needs. It’s vital to have a system that could support your healthcare practice needs to bill the healthcare claims to insurance, find out remaining/unpaid balances, run claim tracking and provide medical billing analytics to help you make strategic decisions in a timely fashion.

Help Patients by Giving them the Flexibility of Patient Payment Plans

We all know that not all patients feel comfortable putting a burden on their Credit Card and cannot pay the full amount as cash-pay clients. You need to consider checking the patient payment plans and offering flexibility to your patients. This would increase the client’s trust in your healthcare practice, and you will get constant payments without sending reminder emails or sending paper statements which is of course another cost.

Healthcare Practice Bad Debts and Old Unpaid Claims

Always check the options of old unpaid claims which most healthcare physicians consider just writing them off. Follow up with payers to see if you get some payments or re-negotiate the price and make final adjustments by accepting less payment but at least getting something out of it. In the case of Auto-Accident Healthcare Claims, most claim adjusters offer the claim settlement which can be an easy solution to get the payment. In the case of patient payment, you can offer the same deal instead of involving a collection agency and paying approximately two-thirds of the bill amount to them. Providing discounts to patients on pending bills would increase your chances to get paid faster. On the other side, this would improve their trust and confidence in your healthcare practice.

Get Help in Maximizing Cash Flow for your Healthcare Practice

If you are facing cash flow issues in healthcare practices and need help streamlining your medical billing workflow, please contact us today and talk to an expert Medical Biller at Top Ranked Medical Billing Company.