Outsource or In-House?
When a step in the medical billing process goes awry, such as insurance verification, dentists, employees, and patients become frustrated (tyler 2015). According to the Healthcare Business & Technology website’s article, “Medical Billing,” “It is estimated that doctors in the U.S. leave approximately $125 billion on the table each year due to poor billing practices.” This “loss in profits” happens partly because “It is estimated that up to 80% of medical bills contain errors” (“Medical Billing”). Consequently, the doctor must send a revised claim to the insurance company again, “[causing] a doctor to have to wait several months or more before receiving payment for their services” (“Medical Billing”). Clinics also lose money because “[medical billing] rules are constantly changing, requiring physicians and administrators to spend time and money on continuing education, software, or staff training to stay current, having a direct effect on the cash flow and profits of a practice” (“Medical Billing”). There are at least two ways to handle medical bills: Outsource them to another company or process them in-house (pVerify 2015).
Outsourcing to a company specialized in medical billing may lead to higher profits for dental clinics (“Medical Billing”). Although clinics could form a billing department, the price of a worker for this task includes “the costs of training, the employee’s salary, benefits, and taxes, as well as compensation for turnover” (“Medical Billing”). For a more economical route, clinics could outsource billing to companies (“Medical Billing”). They deal with “denied claims,” handle insurance verification, and maintain awareness of “the changes in Medicare, Medicaid, and third-party payers” (Hicks 2017; “Medical Billing;” O’Connor 2017). Meanwhile, the clinic’s employees could attend to giving the best service to their patients (Hicks 2017). In the long run, outsourcing could be profitable due to less mistakes and money spent on a billing department (Lowery 2014). Furthermore, TrueShore, “a leading provider of Business Process Outsourcing (BPO) services,” advocates for outsourcing because “companies can save an average of a whopping 60% on operating costs” (2016). Additionally, by giving medical billing to “a revenue cycle management (RCM) company,” “you could boost revenue potential as much as 30%, according to the ADS Complete Guide to Medical Billing Services” (O’Connor 2017).
In contrast to outsourcing, the in-house route gives dentists more authority over medical billing. This route could work well, provided that the clinic employs “a well-trained and experienced billing team” (“Revenue Cycle Management 101”). Joy Hicks, who “provides revenue cycle consulting services to physician practices and small hospitals,” states that patients appreciate paying and talking about their bills in-house (2017). Additionally, dentists have more management over these bills and quickly address mistakes with their billing team in their clinics (“In-House vs. Outsourced Medical Billing: Pros and Cons”).
Insurance verification is a significant part of medical billing since it closely relates to the errors made in claims and the changing rules of insurance companies and programs. Based on the economic and logistic differences between outsourcing and in-house, dentists must choose what works best for them.