The growth of a radiology practice is highly dependent on the effectiveness of its billing procedures, especially for a young practice. The combination of poor billing software and ineffective procedures can cost a practice six figures a year in missed reimbursements.
Radiology groups routinely allocate a significant portion of their resources towards billing, which can result in a net loss unless their procedures are highly efficient. A dedicated billing department may sound like the best way to ensure that a practice receives every dollar it has earned, although this isn’t always the case.
Comparing a practice’s current collections results is an important requirement for determining if it should change billing services. Medical billing can generally be classified into in-house and outsourced services. This paper assumes you are billing in-house and want to determine if you should outsource your billing or insource your billing. This article provides a comparison between these two types of billing services.
Assessing Radiology Billing Net Collections
It may be time for a radiology practice to change its billing service if it’s currently underperforming by a significant margin. Many factors can affect an individual practice’s collections results such as the social and economic status of its patients.
It is important to know that there is not a concrete benchmark for Net Collection Percentage that can be used for all practices. Whether you “control the patient” at, for example, a private imaging center, or doing professional component billing out of a hospital will be an important factor in the quality of the data required to bill. Also, your patient mix will be an important factor as a high percentage of self-pay patients or high-deductible plans will negatively impact your collections. Instead, it is recommended that all practices monitor their percentage over time, keeping an eye on adjustments, bad debt write-offs, and open accounts receivable balances. Nevertheless, national metrics are available as a general basis of comparison and are periodically published by the RBMA.
Insourced Radiology Billing
Insourced billing allows your billing services to remain in-house, although management over those services will be performed by a service provider. This option means that the same billers and coders who previously worked directly for the practice now work for the service provider. Your billing and coding will be moved to their systems and management. This service is exclusively provided by Dexios.
It’s essential for the provider to be highly experienced with this arrangement to ensure a seamless transition between self-billing and a billing department that’s managed by the provider.
Advantages of insourced billing include:
- No cost increase compared from existing billing expenses
- Improved collection rates
- Better efficiencies of scale
- No conversion, just seamless transition
There are several scenarios in which a radiology group should consider insourced billing. These circumstances include:
- Difficulty retaining good employees
- Significantly high billing costs
- Significantly low collection rates
- Trouble keeping up with the latest billing practices
- Generally poor billing management
Insourced Billing Services
The primary mission of the service provider for insourced billing is to offer expert oversight over a radiology groups’ billing procedures. The scope of these procedures includes billing services and coding services.
Billing services primarily consist of the following:
- Filing claims
- Managing claim rejections
- Posting payments
- Performing patient collections
Additionally, billers must ensure that payments comply with the terms of any applicable contracts. Coding services include coding for the Merit-based Incentive Payment System (MIPS), charge audits and addendums.
Benefits of Insourced Radiology Billing
Insourced billing can provide the advantages of billing in-house with the efficiency of a dedicated billing service. There is generally no net cost increase compared to self-billing, even though insourced billing improves collection rates and offers better economies of scale.
The lack of any personnel changes also means that practices can expect a smooth transition to insourced billing. Furthermore, this billing model allows groups to compare their billing performance with that of similar groups throughout the country.
Outsourced Radiology Billing
Outsourced billing involves moving billing tasks out of the radiology group entirely to an independent service provider.
In many industries, “outsourced” is typically associated with shipping production or services overseas, but this isn't necessarily the case with radiology billing. Many billing outsourcers are located in the United States and are still able to deliver superior results at a low cost.
Outsourcers are increasingly likely to reduce labor costs by implementing robotics process automation (RPA) to computerize much of the billing process. This approach requires outsourcers to hire personnel with strong technical qualifications instead of sending jobs overseas.
The healthcare industry primarily uses RPA to process claims, but it's also used in other areas such as accounting and HR.
There are several scenarios in which a radiology group may consider outsourced billing. These circumstances include:
- High billing costs
- Poor collection rates
- Lack of the expertise needed to perform critical billing tasks in-house
Outsourced Billing Services
Outsourced service providers normally handle the full scope of the billing process, including billing and coding services. These services are typically the same whether they're performed by in-house staff, an insourcer or outsourcer.
Benefits of Outsourced Radiology Billing
The costs are usually the same as in-house billing, but outsourcing eliminates the challenges of managing an in-house billing department. Outsourced billing also enables a radiology group to take advantage of a provider’s focused expertise in radiology billing practices.
Medical billing is tightly regulated in the United States, so regulatory compliance requirements change frequently. Expert oversight by an outsourced radiology billing provider ensures you’re remaining within current compliance standards.
Additional advantages of outsourced billing include:
- Reduced cost of maintaining employees, office space and equipment
- Better leverage with vendors that issue statements and perform clearinghouse services
- Greater insight into industry trends that can affect billing practices
- Larger economies of scale
- Expert oversight
Insourced and Outsourced Radiology Billing Solutions
Radiology groups may use a variety of billing services we offer, including insourcing and outsourcing billing.
In-house billing generally becomes more effective as a practice grows, so if you poor collections and find it difficult to maintain good employees, our insourced billing solution may be right for you. A group with billing services that aren’t meeting expectations can indicate a need to change models, especially when collection rates are below those of similar groups.
Insourcing and outsourcing both offer distinct benefits, so it's important to understand the root cause of poor billing performance before making any decisions.