The practice of medicine is comprised of numerous specialties. Doctors train for over a decade to obtain the skills necessary to successfully practice medicine in their chosen field. Additionally, they must continually stay abreast of technological advances and the changing protocols in their chosen specialty to ensure they are providing the best possible care to their patients.

You won’t find a general practitioner performing a triple bypass on their patients. The skill and complexity of that operation requires a specialist.

Similarly, given the complexity of today’s revenue cycle processes, it takes the specialized skill of medical billing professionals to ensure your practice’s economic success and compliance with the plethora of government regulations. Billing is no longer something someone does to fill in the time between scheduling and rooming your patients.

When I first started in the medical billing field, things were much simpler. Payers would occasionally change a rule and give you ample notice to adjust your processes. Denials averaged less than five percent of total claims. Today, if you don’t have sophisticated claim scrubbing software, it’s not unusual to have a 35 percent or higher claim rejection rate which requires extensive and expensive follow-up.

The challenges that your internal billing operations are faced with on a regular basis can lead to collection shortfalls and non-compliance issues. Here are some reasons why outsourcing your billing to a professional practice’s management/billing company makes sense.

Regulations change constantly which means that dedicated personnel must have the time to read bulletins, interact with payers, and attend industry seminars and webinars.

Billing managers should be certified to ensure their competency. One such designation is the Healthcare Billing and Management Association, CHBME designation.

Coding personnel who have the responsibility for ensuring that your documentation and coding is compliant with the new ICD-10 requirements should also be certified by one of the accredited coding organizations.

Implementing and maintaining a compliance plan can be expensive for an individual practice. A professional billing company can spread the cost of their compliance professionals across many clients.