The 3 Most Time-Consuming Tasks in Medical Billing: Why You Need to Outsource

Posted on October 31, 2022 by Kylene Ordway

As your healthcare practice or business grows, there is a need for added support to manage your medical billing. Yet, even in a small practice, it is now more difficult than ever to ensure you have enough people putting the right amount of time into each aspect of your office management. Often, billing is a thorn taking up too much time and leading to frustrating results. With the help of medical billing services, it may be possible to streamline your practice and create a better, long-term outcome.

What Is Holding You Back?

The following are the three most time-consuming tasks required in medical billing. If you are still doing this in-house, chances are good this is what takes your employees so long to move invoices and payments through the system. It can be frustrating, especially when your patients are unhappy with the billing processes and don’t always come back for the care they deserve and need as a result.

#1: Authorizations

Authorization is just what it sounds like. It is a type of pre-approval or precertification stating the patient can receive care from your practice. For the health care plan, it is a type of cost control measure. In your healthcare office, it is one of the most important first steps in providing care to a patient.

Your team has to ensure that you receive advanced approval from the plan to provide the specific services the patient needs. That is not always easy to do, especially if there is any type of misunderstanding or misclassification of the process. Yet, not doing this well nearly always leads to denials for coverage and very frustrated patients.

Many non-emergency medical procedures and other types of medical care require pre-authorization. It is very common for practices to find themselves balancing this process while providing care for patients, especially in a smaller practice where the physician and team are handling these types of tasks themselves.

#2: Eligibility

Eligibility verification is a process that enables verifying the individual’s coverage is active. This is done directly with the insurance company and is typically done in situations where the individual is being admitted to a hospital or needs care right away. Verifying the authenticity of the patient’s claims is also important in this step.

The problem here is that when there are many things happening at one time, it is hard for a provider to ensure every step is completed according to the insurance company’s requirements. Small mistakes can lead to very big problems later when patients receive bills far exceeding what they expected. That may reflect poorly on the practice. It also makes it difficult for the provider to gain access to the medications needed.

Typically, all patients should receive eligibility verification. That includes admission into a hospital, any patient who states their coverage has changed in some way, and any high-value procedures most likely to get a kickback from the insurance provider.

#3: Denials and Audits

The third pain point in medical billing tends to be claim denial. It is an entire process of its own to manage denials (as well as audits). It is very common for this to occur due to missing information, human errors, limit for filing expiration, duplication claims, and services not covered by the payer. Yet, every time there is a delay of any type, that creates a scenario in which the patient is receiving inaccurate medical bills, and practices do not receive the funds necessary.

Audits typically are very time-consuming and may often be pushed to the side because of the lack of time needed to manage the process. This, too, is a time when practices just cannot do all that is needed without taking time away from patients.

Keeping Employees Ready

When you outsource your medical billing, ensure you are working with an organization that keeps employees up-to-date and highly skilled. Training is ongoing with payer changes. That is why it is so critical to have a team that is skilled at consistently meeting those changes as they occur. There are various modes of education used to ensure this. That may include emails, rounding, meeting with payer representatives, and gathering insights from them. Additionally, Medicaid and Medicare training sessions are necessary and ongoing.

Finding Support Is an Option

Medical billing services can alleviate these risks. It works to provide a far better opportunity to streamline practice billing methods to reduce complications and ensure better patient care and practice management. Outsourcing medical billing services can assist with unprocessed denied claims, legacy clean ups, and much more. Make sure your team is focusing on what matters, your patients, and let an expert step in to help with some of the most time-consuming tasks.