Outsourcing Medical Billing: A Comprehensive Guide for Your Practice

Touseef Riaz

October 27, 2020


If you run a medical practice, you know that medical billing is perhaps one of the most complex and time-consuming aspects of running a successful medical practice. The ability to have effective and efficient medical billing can be a real challenge with thousands of possible medical codes for procedures and diagnoses, and multiple payers.

There is no doubt that medical billing is the workhorse of the modern medical services industry. Note that a competent medical biller will ensure that your patients’ claims are accepted by the relevant insurance companies so that you can get paid on time.

In contrast, if you hire your medical staff for billing, note that you’ll be responsible for medical coding as well as claims. Also, you will likely need a certified medical coder and other personnel in order to handle rejected claims.

There are many reasons medical practices may decide to outsource their medical billing to a professional provider. For example, you may be operating with a skeleton staff and just lack the human capital to devote enough time to managing that aspect of your revenue stream.

If you are in search of a medical billing company to help you increase your revenue, you have to consider many things to get the most out of medical billing outsourcing. It is worth noting that partnering with a reliable billing service can usually be a long-term agreement that can have a profound and lasting effect on the financial well-being of your practice. 

Did you know that some healthcare organizations and hospitals gain more immediate benefits from medical billing outsourcing than others? You may be an ideal candidate for medical billing outsourcing if you often struggle with several issues and problems at the same time, and also don’t have the resources in order to meet the challenges and increase profitability.

When to Outsource Medical Billing

Outsourcing medical billing is ideal in these situations.

Your Run a New or Growing Practice

If you are the manager of a new practice, you know that you have your work cut out for you. Note that, like most startups, you will often have to learn and perform everything, such as billing, on your own. You may also have a tight budget.

On the other hand, if you have a growing practice, some of the common challenges you will face are the need to find experienced and skilled staff fast and handle a high volume of claims efficiently and effectively.

The best thing about working with a professional medical billing provider is that it helps both new and growing practices address problems cost-effectively while meeting their financial goals and objectives.

Needed Expertise and Experience

While physicians, doctors, and healthcare providers are great at patient care, they might not be as strong and effective on the business and financial aspects of things. A majority of doctors would like to spend time with the patients, rather than handle the tedious but essential paperwork.

If you do not have the expertise to perform administrative tasks effectively and improve profitability in-house, then it is sensible to work with a reliable outsourcing partner.

Market Disruptions and Regulatory Changes

You know that regulatory changes are quite disruptive to the US healthcare industry. For example, the financial effect of the ICD-10 transition has had a considerable impact on physician practices. Keep in mind that industry experts and professionals believe that the transition to ICD-10 requires considerable changes to the existing practice management systems and investments in both staffing and training.

If you cannot handle these changes, medical billing providers will help you ease the transition while improving collections and allowing you to focus on your patients, which is great.

Questions to Ask Before Outsourcing

Keep in mind that the key to success is outsourcing wisely. And this means establishing and defining your needs, strategy, and scope before you engage potential vendors and choose a medical billing company that can meet all your needs, especially in the long term. Here are some questions that you have to keep in mind before making the decision.

What Functions Can Stay In-house?

It is worth noting that if you are not willing to outsource all aspects of your back-office operations, you can retain some medical billing functions internally. So, for instance, you can keep coding or customer service in-house while tasking a third-party provider with payer management and claim submission.

It is important to determine what areas you want to keep in-house, and then find a billing service that can adapt their service offerings to better fit your scope and needs.

What Type of Support do You Require?

Some medical practices can do with 9-5 service representatives as well as a call-based escalation process. In contrast, others need 24/7 and always-on access to their customer service experts and billing specialists.

Can a single dedicated account manager meet all your expectations and needs, or do you need multiple teams leads on your medical practice’s service engagement? It is vital to design your outsourced medical billing model prior to pursuing a vendor contract.

How will Outsourcing Affect the Patients?

Note that while your front-desk team usually interacts more with the patients than the medical billing staff does, remember that there are some interactions and key decisions that your back-office staff makes now (like collections and write-offs) that would be placed in a medical billing provider’s hands. So, it is important that you prioritize your patients’ interests and needs in the decision-making process.

Things to Consider when Choosing a Medical Billing Provider

You know that choosing the best outsourcing partner for your practice is important to making your processes more efficient and effective and ensuring a stable flow of revenue to your medical practice. Here are a few things to look for in an outsourcing partner.


Compliance with HIPAA (Health Insurance Portability and Accountability Act) is important for your practice. HIPAA is a law that protects sensitive medical information via data privacy as well as security provisions.

Keep in mind that choosing a HIPAA-compliant solutions partner will help ensure that the company not only pays attention but is also dedicated to protecting patients’ confidential health information and legal rights. Besides HIPAA, you should also confirm that your outsourcing provider upholds other medical regulations, laws, and guidelines.

Expertise and Experience in Your Specialty 

Whether your practice specializes in nephrology, pain management, or pediatrics, note that different specialties often have unique billing challenges. And this means you have to find a reliable medical billing provider with coding expertise and experience in your kind of practice to get the best results.

This is because the company will have better knowledge and expertise of your specialty’s requirements for coding, documentation, compliance, and much more. If you fail to choose a company that has sufficient expertise in your specialty, it may cause coding inaccuracies as well as claim denials.

History and Reputation

Reputation is everything in business. And it is evident that people judge businesses on the basis of past performances. This is why customer reviews, as well as case studies are very important. Note that in the medical field, patients trust you with their most sensitive and confidential health information. So, trust has to be built between providers and patients.

When you choose a medical billing partner for your practice, a complete and comprehensive background check is one of the basic requirements.

Dedication to Improve Services

There is no doubt that a good medical billing provider will offer you the minimum services required. However, an excellent medical billing firm will constantly improve their use of technology and upgrade the various services they provide in order to help you solve the changing and ever-emerging challenges and complexities of your industry.

An example of this service may include an online patient payment portal that can help your medical practice in overcoming a great number of high deductible healthcare plans.

Cost of Services

If you run a medical practice, you know that cost is an essential consideration for any service. Note that how high or low you will go will likely depend on your organization’s budget. You have to look beyond merely the monetary figures and personal costs when deciding on the price of the services.

It is better to consider the overall package that you are interested in. Consider the level of expertise and experience that the outsourcing provider offers and the technology they use.

Note that, at times, it is reasonable to pay a bit more. This is because the value you are receiving more than justifies the total cost.

Communication and Transparency

In many cases, finding the time and other resources to train your staff can be a problem. This is especially true if your medical practice is growing rapidly. This is why hiring a medical billing firm that is committed to helping your staff transition smoothly is important for success. Keep in mind that the training and self-education tools provided by the billing partner can mean all the difference between relieving heavy burdens on your staff and adding other points of contention.  

And this is the reason communication and transparency are important qualities that you look for when comparing various medical billing companies for your practice. Does the outsourcing company guarantee a quick response, even after hours? And how regularly are software updates issued? Also, you would like to ensure that there is a policy that allows key staff to contact authorized employees at the billing agency in case an emergency arises or you require an immediate answer.

Final Thoughts

Whether your medical organization is experiencing a growth spurt, or you’re looking for new ways to make your medical practice more efficient and effective so you can start marketing efforts in order to drive new patients, it is sensible to consider outsourcing your medical billing services. Note that outsourcing with a reliable and experienced company can add many benefits, provided you carefully vet all the contenders.

You May Also Like…


Submit a Comment

Your email address will not be published. Required fields are marked *

Ready To Get Started?

Pin It on Pinterest