Healthcare regulations in the US are in constant flux. The legislative bodies introduce new laws and amendments to protect patients and ensure fair billing practices. The Centers for Medicare and Medicaid Services frequently implement countless regulations. However, these regulatory changes are affecting the health system billing services as the healthcare staff don’t have knowledge of this. The providers need to adhere to all the regulation changes, otherwise it can lead to billing errors. Apart from that, there is a dearth of billing experts in the healthcare industry. That’s why the health systems are feeling the strain, struggling to keep their finances on track. Now that you have gained an idea about the issues prevailing in the healthcare industry, let’s know how third-party billing services can increase your ROI.

Advantages of Hiring a Health System Billing Company

• They comply with the updated regulations: Healthcare regulations are not only complex, but they change daily. CMS implemented the Patient-Driven Grouping Model (PDPM) to determine Medicare payments for healthcare providers. It focuses on segregating patients based on their clinical characteristics, medical requirements, and goals. Moreover, the healthcare providers need to adhere to the Condition of Participation (CoPs) mandated by CMS. It specifies the standards of staffing, patient care and also documentation. It ensures that the treatment and the medical services are delivered safely to the patients. Hence, the providers need to keep a thorough and accurate record of patient treatment. Now, as the healthcare staff mostly do all the healthcare operations, that’s why they don’t get enough time to get updated with the latest regulations. On the other hand, the experts of the billing services use accurate CPT, ICD, and HCPCS codes to communicate with the insurance companies about the services provided and the patient’s condition. Along with that, they also know about PDPM, CoPs, and other regulatory changes affecting the healthcare industry. That is how they streamline the billing process by having knowledge of all the complex coding nuances and regulatory changes.
• They help with prior authorization: Prior authorization is a complex process to manage. Moreover, it takes a lot of time to perform which leaves the healthcare staff no time to focus on patient care. That’s where the health system billing company comes into the picture. Their dedicated experts verify the patients’ insurance eligibility, collect all the patient details, and then submit the PA request to make sure no claim denial occurs. Moreover, these experts also help with claim follow-up services to make sure no claim denial occurs.
• These experts are highly cost-effective: The in-house billing team comes with a higher cost. It’s because you have to train them and also buy separate office space for them. On the other hand, the third-party billing experts are highly cost-effective compared to the in-house team. It’s because you don’t have to train them and the outsourced billing companies provide separate office space for them, which you also don't have to bear. That’s how they come at 80% less cost compared to the in-house team.

Healthcare providers perform almost all healthcare operations. That’s why they don’t get enough time to invest in patient care, which leads to decreased patient satisfaction. On the contrary, the health system billing company has dedicated experts who stay updated with all the complex coding nuances. Moreover, they also know about working with your client’s EHR, so that you don’t have to train them. Apart from that, they are 80% cost-effective compared to the in-house team. So, if you want to streamline your billing operations, you may consider outsourcing a third-party billing expert so that you can invest your time in patient care.