Medical billing and medical coding are two of the most time-consuming and tedious tasks for modern health professionals. However, medical institutions effectively remove this major administrative burden when they outsource medical billing and coding to a qualified business process outsourcing (BPO) partner.
Healthcare BPO specializes in managing the complex ecosystem of insurance, medical paperwork, and payment management so in-house professionals can focus on directly serving patients. With the complex coding and billing system off their plates, healthcare providers are able to be more focused, efficient, and effective.
The Challenges of In-House Medical Billing and Coding
A vast majority of healthcare institutions in the United States rely on health insurance to get paid. In order for insurers to process payments, they need the right paperwork, which often involves deciphering medical jargon and selecting the right insurance code for different kinds of treatment.
Even for providers who don’t take insurance, managing patient invoices and collecting payments can be a challenging task. There are several ways that trying to manage these tasks internally can decrease efficiency and introduce errors into the billing process.
Keeping Up with Ever-Changing Coding Standards
Healthcare professionals input codes based on standardized systems from insurers. However, these standards can change frequently. As coding requirements evolve, it can be challenging for in-house admins to keep up with new developments, especially when working with multiple carriers. Even small changes can lead to denials and reversals, requiring internal teams to take on the additional burden of handling appeals and making corrections.
Regulatory Mandates and HIPAA Guidelines
Medical professionals face increasing difficulty keeping up with constantly evolving regulations and HIPAA requirements. Daily responsibilities already demand full attention, and staying current with policy changes adds a significant burden. Frequent updates, complex compliance standards, and the risk of costly penalties create stress and administrative overload. Balancing patient care with regulatory obligations requires ongoing education and vigilance, making it challenging to maintain compliance while focusing on delivering high-quality care in an already demanding healthcare environment.
Staffing Shortages and Training Gaps in Healthcare Admin Teams
Healthcare worker shortages are on the rise, including for administrative and clerical roles. Even if an institution has the financial resources to manage the payment cycle internally, it may not be able to hire enough support at any given time. It can be challenging to find experienced administrators who understand the insurance system and are already familiar with coding standards. Upon successfully hiring new employees, healthcare providers will still have to train them appropriately, which can be both costly and time-consuming.
Why Healthcare Providers Are Turning to Outsourcing
Because of these challenges, healthcare providers have begun to lean heavily on outsourced medical billing services. Instead of putting unnecessary stress on their administrative and care teams, healthcare institutions are using medical billing and coding outsourcing as a way to improve performance and efficiency. Healthcare BPO services have the tools and resources available to streamline payment processing, enabling them to alleviate the main pain points of using an in-house team while also offering several additional advantages.
Access to Certified Experts Without Hiring In-House
Healthcare BPO organizations already have insurance and administrative professionals on staff, so their clients don’t have to go through a lengthy hiring process to get expert guidance and advice. BPO representatives have an in-depth understanding of insurance and medical payments processing, so providers can hit the ground running instead of having to train internally to fill critical knowledge gaps.
24/7 Availability and Faster Turnaround Times
Many third-party BPO companies come equipped with patient contact centers that offer 24/7 availability. They’re constantly working to answer patient questions, process payments, and resolve claims issues. Instead of being bound to a practice’s normal business hours, they can work around the clock to speed up claims processing systems and provide immediate support for time-sensitive tasks.
Constant Maintenance and Training on New and Updated Regulations
A BPO partner leverages advanced compliance management systems, industry-specific expertise, and continuous staff training to ensure adherence to regulatory requirements. They monitor legal updates through automated tools and dedicated compliance teams, enabling them to quickly implement necessary changes. With robust risk management protocols and real-time tracking, BPO partners help healthcare professionals stay compliant and avoid penalties. Their proactive approach ensures ongoing alignment with evolving regulations across industries and jurisdictions, providing peace of mind and operational continuity.
Cost Efficiency Without Sacrificing Accuracy
One of the main medical billing outsourcing benefits is cost effectiveness. Healthcare outsourcing teams specialize in handling administrative tasks such as coding, billing and insurance claims processing. As such, they can offer the same level of accuracy at a lower cost than managing an in-house team. Because they operate at scale, they can pool their resources to provide affordable, top-tier service to several healthcare institutions at once.
Improved Reporting and Analytics
In many cases, in-house teams are scrambling to keep up with claims and the payment process, making data analysis an afterthought. Meanwhile, outsourcing companies are able to conduct thorough data analysis and reporting on top of their basic administrative tasks. This provides healthcare professionals with critical insights to further improve their patient care, payment processing, and insurance protocols.
Streamlined Revenue Cycle Management
Insurance is a key part of the revenue cycle for any health professional. Institutions need to liaise with both patients and insurers to get paid. By outsourcing billing and coding to a third party, they can speed up the claims process and get paid more quickly, instead of going through a tedious back-and-forth to get each claim approved.
How Outsourcing Reduces Claim Denials and Errors in Billing and Coding
Using an outsourced solution can also simply reduce frustrating administrative errors that slow down the claims process and introduce additional barriers to patient care. How outsourcing medical billing reduces claim denials comes down to scale and specialization; in-house healthcare admins are often distracted by dozens of ongoing tasks, while third-party BPO teams can fully focus on their data entry and payment processing tasks. BPO organizations have in-depth systems for data entry and recordkeeping, decreasing the incidence of human error and making it easier to flag mistakes. Medical institutions can reduce billing errors through BPO by tapping into these systems and leveraging their resources.
Future Trends in Outsourced Medical Billing & Coding
The medical billing outsourcing market is expected to exceed $30 billion by 2030, a massive increase from the 2023 market size of $13.4 billion. As part of this rapid expansion, BPO providers are likely to scale their workforces so they can serve more patients and providers without sacrificing their performance. Technological innovations, such as AI-driven data entry and data analysis, are also likely to improve their overall efficiency and reduce the frequency of human error in the billing process.
You Can Focus on Care
Medical providers face a variety of challenges when it comes to billing, from a lack of trained staff to the frequency of human error. By working with an outsourcing partner, they can reduce administrative errors, process claims more quickly, and ultimately streamline their administrative workloads. Because billing and coding are so central to the entire medical system, using an outsourced solution is essential for modern providers to remain competitive and provide top-tier care.
Confie BPO has an extensive track record of success when it comes to healthcare administration, including billing and coding. The trained, certified experts on the Confie BPO team are ready and waiting to overhaul your payment system, giving you more time to focus on your patients. Reach out today at 800-684-2276 or connect with us online to start your outsourcing journey.
