The decision to outsource your billing functions can be stressful and complicated impacting staff, patient flow, and ultimately, the bottom line. Laboratory billing has always required a specific set of skills and knowledge, but with significant bottom line pressure from shrinking margins and changing payment structures, it has become critical to explore the benefits gained by streamlining the reimbursement process.
If you are currently using a third-party partner in some component of the healthcare payment lifecycle, now may be the time to broaden their scope and scrutinize the level of technological support they are offering. An external partner’s role should be automated and streamlined, while also leveraging the benefits of artificial intelligence and machine learning.
What are the Benefits of Outsourcing Laboratory Billing?
Outside of providing patient care insights through testing services, the healthcare payment lifecycle is arguably the most important activity in any laboratory. Understanding the billing intricacies of laboratories is complex and staying current is a constant challenge. Here are three operational complications that can be positively addressed when partnering with an outside vendor:
1. Finding Highly Trained Specialists
When you partner with an outside group, you are purchasing the skills and know-how of a specialized team dedicated to providing you with the highest quality of billing services. You can expect that they have the latest knowledge and training in their field of expertise, as well as an in-depth knowledge of each insurance carrier and their latest updates and changes.
2. Ability to Gain Economies of Scale
It is always difficult to anticipate resource and staffing needs when business levels change, but with an outsourced solution, you no longer have that concern. It will be up to the outside organization to scale up or down based on their clients’ needs. The savings and efficiencies are passed onto you without the headache of day-to-day human resources issues.
According to a AMA survey, 92% of physicians report that the prior authorization system causes delays to patient care and can lead to care abandonment. Further, once a request is rejected by a commercial insurance carrier, it can cause delays from two days to two months. Drilling down through the prior authorization process and identifying/correcting problems yields huge benefits further down the reimbursement line by reducing denials and improving patient relations.
3. Transparency and Follow-Up
An outside vendor is compensated on amounts collected and so is highly motivated to submit clean claims and to collect your amounts outstanding in a timely manner. Equally, they are interested in investigating and resubmitting outlier claims quickly to add to your bottom line (and theirs).
How Can Outsourcing Billing Improve My Bottom Line?
Ultimately, the goal is to capture the maximum revenue for the service provided within the contractual agreements held between your lab and the insurance carriers. By utilizing a third-party partner, you gain the following:
- Effectively Steering Through a Changing Reimbursement Landscape—With rules and requirements in constant flux, you can reduce the administrative challenge of navigating the billing process and rely on expert support for your reimbursement activities.
- Consistency—In-house billing is susceptible to revenue disruption from unplanned staff changes. With an outsourced service, you are less vulnerable to any sort of cash flow interruptions.
- Faster Reimbursement—Your bottom line is dependent on smooth and accurate processing of the various components of billing. Using a professional third-party company will maximize your reimbursement, achieving the highest amounts possible quickly.
By partnering with a third party, you gain expertise and proficiency that will improve the timeliness of your reimbursement, as well as expert contract management and analytics to better run your business. However, the real value to you and your lab will be the ability to focus on what you do best—patient care!
Read more and schedule a demo to see how we can help you improve your laboratory’s bottom line.