Written by Rene Mallari
Running an oncology practice is not easy. You have to carry out two critical tasks—patient care and financial management.
But your specialty as an oncologist is patient care. Dealing with finances may not be your strong suit. And then you find out that your medical billing team can’t handle the growing workload anymore. What should you do then?
The best option left for you is to outsource your billing processes. But why should you? Why would you entrust your finances to an outsider?
This article explains the reasons you should outsource this administrative task. Read on and find out.
What Is Third-party Medical Billing?
Third-party medical billing companies are external service providers specializing in managing billing processes for medical practices. Their services also cover your in-house oncology medical billing or revenue cycle management (RCM) operations.
Instead of your own billing staff taking care of billing, a third-party vendor assumes the responsibility of overseeing your RCM activities. It can perform your financial operations completely (end-to-end RCM) or partially (front-end, middle, or back-end RCM). The RCM tasks you can assign to a third-party vendor range from claims submissions and follow-ups to handling rejected or unpaid claims.
In addition, many medical billing companies offer various services for your outsourced oncology billing. These include patient registration or demographic entry, insurance eligibility verification, medical coding, indexing medical records, charge entry, electronic claims transmission, payment posting, and patient balance monitoring.
While external medical billers mainly file medical claims with healthcare insurance companies, they also directly address patients’ questions and concerns about their invoices. They should competently resolve issues between healthcare providers and payers to improve patients’ overall experience.
Medical billing companies are here to stay; the market is expected to thrive in the following years. According to Research and Markets, a business research firm based in Ireland, the U.S. medical billing market will reach $8 billion by 2026 from over $4 billion in 2020.
How Does Third-party Medical Billing Help Your Oncology Practice?
Outsourcing oncology medical billing services to a third-party service provider is typically a cost-effective way to create and submit insurance claims to payers, mainly consisting of government agencies and private insurance carriers.
A billing specialist can track the submitted claims or accounts receivable and manage those denied by insurance carriers. For the most part, an external medical billing team uses the latest billing platforms such as practice management software (PMS) or an electronic medical record (EMR) system to closely monitor the status of the claims and the oncology practice’s financial processes.
Third-party billing organizations should make your RCM operations more efficient to boost your total revenue collection and daily cash flow. They should also have the broad knowledge and the expertise to meet your business requirements and the everyday challenges of your practice.
Why Does a Healthcare Provider Hire a Medical Billing Company?
Most medical practitioners start their practices with a small in-house billing team to manage the RCM processes. Their opportunities grow as they serve more patients.
Similarly, billing operations will increase as you issue more and more patient invoices—or as you bill Medicare/ Medicaid for services rendered. Handling all these complex billing tasks with a limited staff becomes unavoidably overwhelming. Not being able to immediately and efficiently resolve the growing number of invoices leads to a considerable backlog.
As you are well aware, unlike most service providers, medical professionals are not paid on the spot. Your revenue mainly depends on the reimbursements from payers that approve the claims. It can take a while to receive them.
Backlogs or payment delays because of insufficient internal staff will put a financial strain on a practice. Such a scenario can adversely affect its daily operations. The growing volume of documents to process by a few employees can also cause inaccuracies, oversights, and disorganization.
Hence, the healthcare practitioner will need a group of professionals or an entity that can start immediately to tackle its billing problems and deliver a tangible outcome with a short turnaround time. This business strategy is possible and can help the practice overcome its challenges.
The medical provider likewise needs an external billing team who can immediately establish a rapport with patients and insurance companies to begin the work. The external team must familiarize itself with the practice’s billing processes, patients, payers, and platform in a short time to meet the financial requirements in a timely and accurate manner.
What an External Billing Company Can Do for Your Oncology Practice
An external medical billing company can offer front-end, middle, and back-end RCM services for your oncology practice.
The front end starts when a person steps into the clinic or facility and talks to the staff to seek medical help. It refers to all the tasks that involve patients, such as patient scheduling, registration, eligibility and authorization, and upfront collections.
The middle of RCM refers to the activities from the time of admission to a couple of days after discharge. These tasks include case management, medical coding, medical health information management (HIM), and change management.
The back end involves creating and submitting medical claims, claims management, and final patient balance collections. The last part of CRM deals with all patient accounting services, including insurance follow-ups, denials management, and cash posting.
An external billing provider can also provide your oncology practice with regular financial reports to keep you updated on your cash flow status. Providing financial highlights and summaries can help you identify potential money problems.
Furthermore, a third-party vendor can offer you regular follow-ups on denied claims. Mistakes can happen once in a while. But your external billing team makes sure that it will follow through with all the claims until resolved.
The Four Benefits of Medical Billing Outsourcing
1. Streamlined Processes
Unexpected staff changes and employee resignations or sick leaves are situations that can disrupt your in-house billing operations. But through outsourcing, you enjoy the advantages of experienced and skilled specialists who guarantee that your oncology claims are processed efficiently and accurately.
In particular, a reputable external service provider allows you to avail of its dedicated workforce that manages the filing of your claims. It specializes in generating claims from clinical notes, cleaning or scrubbing the claims, transmitting them to the clearinghouse, and regularly coordinating with payers for the payments.
2. Lower Operating Costs
Outsourcing RCM processes to a reliable third-party vendor enables you to reduce your administrative expenses and other facility-related costs. These costs include employee salaries and benefits, bonuses and raises, healthcare insurance, computer hardware and other related equipment purchases and maintenance, clearinghouse fees, training costs, and additional office space. Outsourcing is an effective way of saving a substantial amount of money on total operating costs related to the internal billing office.
3. Access to the Latest Billing Technologies and Systems
Established BPO companies typically use the newest technologies to help you meet your billing needs. They use PMS or EMR systems or both.
Moreover, experienced medical billing specialists are knowledgeable of the medical coding systems that affect oncology billing guidelines. They stay abreast of the constant changes in these coding systems, such as the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Healthcare Common Procedure Coding System (HCPCS), and Current Procedural Terminology (CPT).
Hiring a BPO company can help you address various oncology coding issues that you normally deal with. It can also keep track of oncology medical billing trends to help you identify potential problems to avoid and opportunities to take.
4. Increased Revenue
When you have streamlined billing operations, payment collections become more efficient.
An external service provider is an expert in every aspect of your RCM processes and is well-versed in the latest government regulations and industry policies, so coding and billing errors are significantly fewer. Error-free and clean claims result in faster approval and reimbursements.
That said, your past-due accounts receivable will correspondingly decrease, and cash flow will increase. A healthy and sustained cash flow will allow you to expand your practice or improve the financial well-being of your employees.
Outsourcing Your Oncology Medical Coding Services
Like oncology billing, you can also outsource your coding tasks to any third-party provider specializing in this field. Research and Markets report that the global medical coding market is expected to reach about $30 billion in 2026 from roughly $18 billion in 2021, at a compound annual growth rate (CAGR) of almost 11%.
Why You Should Outsource Your Oncology Coding
Outsourcing your oncology medical billing services to a third-party vendor will address the complex challenges and issues of oncology coding. It will allow you as a healthcare practitioner to spend more time on patient care.
What makes oncology coding different from other medical coding areas is that it includes more intricate and time-dependent services. One rejected claim by a payer due to a minor coding mistake will cost the practice a hefty sum.
Seeking the help of a BPO company can ease your coding burdens. It has the expertise, resources, and technology to efficiently identify, evaluate, and address your coding problems.
Quick Tips on Oncology Coding Outsourcing
Below are some tips that you should consider before deciding to outsource your oncology coding tasks:
1. Make sure the medical coding company is HIPAA-compliant.
It is best to partner with an external service provider that complies with the Health Insurance Portability and Accountability Act (HIPAA), a federal law that protects sensitive patient information. This will ensure that the BPO company is transparent in managing patient data.
2. Identify the external group’s coding expertise.
Be certain that the BPO company is proficient in all the medical coding systems your oncology practice uses. Check whether the third-party vendor updates its coding approach regularly.
3. Know the BPO company’s coding market knowledge.
Identify the medical coding provider’s expertise level in market trends, government regulations, and industry policies. These indicators have a direct effect on your oncology coding operations.
4. Research each potential partner.
Research each of your candidate’s reputations and performance. Call their previous clients and get their feedback. Look for independent online reviews about them.
5. Learn about the BPO company’s technology solutions.
Your prospective medical coding provider should use the latest and most relevant electronic or online systems to support your coding processes. Cloud-based billing solutions are one example.
6. Fully understand the third-party vendor’s service rates and conditions.
Ask everything about the services they offer and the rates of each service, including hidden costs. Inquire also about the details of its terms and conditions.
Generally, the benefits of medical billing outsourcing outweigh its disadvantages. What makes outsourcing appealing to many oncology practitioners is that it takes away the hassles of financial supervision.
Fewer worries about cash flow management mean more attention to patient care. Importantly, this business strategy is cost-effective. But like any other venture, you should adopt outsourcing with caution. Do your due diligence first.
This article gives you the benefits medical billing outsourcing can offer your healthcare practice. But you also have to know the drawbacks to make an informed decision. After all, there are two sides to every story.