Apples & Oranges: In-House vs Outsourced ENT Medical Billing

apples-orangesIf you have been considering outsourcing or hiring a consultant to improve your medical billing services and train your staff for the ICD-9 changes for 2015 to ICD-10-CM, this article may help you make your decision. The changes coming to Ear, Nose and Throat or ENT billing and coding are vast and, in some cases, confusing. Proper training and education is required in order to prepare in-house medical billing services for the implementation of the new requirements. As a result, many physicians and clinics have opted to hire a third-party medical billing services to process claims. Others have opted to hire healthcare consulting services to properly train and educate staff so they can maintain control of billing coding and management to keep it in-house.

Medical Billing Services: Considering the Cost
For many businesses and practices, it all comes down to comparing solutions by cost. How much will it cost for you to outsource medical billing services? How much will it cost to hire a healthcare consultant to train and educate your staff? It pays to get some real numbers when it comes to ENT billing and coding. While you want to make sure that you are maximizing the potential of your current billing system, you also want to make sure that you are prepared to handle the ICD-10 and ICD-9 changes for 2015. Failure to do so could end up costing your practice or clinic a lot more in the long run.

When comparing outsourcing to in-house medical billing services you need to understand that it is really an apples to oranges comparison. Associated costs with in-house staff for billing coding and management include hourly wages, overtime wages, training, education, certification, benefits, insurance and costs for maintaining software, hardware, office supplies, space for the billing department and other required equipment. When thinking about cost make sure to figure in all of the factors.

Billing Coding and Management: Processing Claims
Part of ENT billing and coding means processing insurance claims, which require a number of steps for each account. Data is entered into the medical billing software program via the superbill, which contains all of the information about the patient’s diagnosis and treatment codes, as well as other important information. The insurance company evaluates the claim to determine whether or not it is legitimate. The claim is then submitted to a medical billing clearinghouse, which will then again verify the claim and check for errors before it sends the claim to the payer to reduce rejection rates. Once the claim is accepted or rejected by the payer, the clearinghouse is notified of the claim status so it can update the provider. Rejected claims can be resubmitted once additional information is provided, with the practice being charged for each submission.

When medical billing services are handled by outsourced medical billing services, the overall process is much more streamlined. Superbills and patient data are scanned and sent electronically to the medical billing service by the practice. All of the data entry and claim submissions for the ENT billing and coding are taken care of by the service, handling all of the “dirty work” for the practice or clinic. Rejected claims, delinquent accounts and invoicing are all handled by the outsourced service, expediting payments and making the entire process more convenient for the practice.

5 Reasons in Favor of Outsourcing Medical Billing Services
Outside of the factors that we have already reviewed with regard to cost and convenience, there are other reasons why many ENT practices and clinics have made the decision to turn their billing coding and management over to an outsourced service provider. Again, beyond the considerations regarding the ICD-10 and ICD-9 changes for 2015, there are many advantages associated with outsourcing ENT billing and coding services.

  1. Efficient & Effective – The processing abilities of managed medical billing services are much more effective and efficient compared to in-house billing coding and management at most ENT practices and clinics. Most of our clients at MD Pro Solutions are able to increase revenues by as much as ten percent just within the first year.
  2. New Practices – When new ENT practices are getting started, they often don’t have the financial support necessary to create their own in-house billing coding and management department. ENT billing and coding can be done by an outsourced provider and eliminate staffing, technology and education costs.
  3. Tech Issues – Another reason why many are opting to outsource medical billing services is the costs associated with keeping up with the current technology. Costs for new computers, upgraded operating systems, software and more can require a lot of financial investment up front, as well as training and education for staff members.
  4. Staff Considerations – Every industry has varying degrees of staff turnover and the medical industry is no different. Many employees who have worked for years with ENT billing and coding have decided to move on to other work following the ICD-9 changes for 2015 because they aren’t willing to learn the new coding requirements.
  5. Time Management – Some physicians prefer to stay focused on their patients and not be concerned with medical billing services. Hiring a team of professional ENT billing and coding experts can help you put all of your time and energy into serving your patients’ needs.

Ready to Outsource or Hire a Consultant?
If you are ready to make a decision with regard to the billing coding and management of your Otolaryngology practice, contact MD Pro Solutions. Our healthcare consulting services can help you make the best possible decisions with regard to ENT billing and coding to find the solutions that are right for your practice and your budget. We can help you with training and education or help you find an outsourced solution for your medical billing services. Give us a call today at 508-946-1665 to find out more about our services or to schedule an evaluation.