The Important Reasons for Outsourcing Medical Billing and Coding Services

The Important Reasons for Outsourcing Medical Billing and Coding Services


The most important objective of a healthcare system is to provide necessary care to the patients to enhance their health and also provide financial support to the numerous healthcare providers who play a crucial part in ensuring the health of the patients.

Like every other business sector, the healthcare sector also requires proper financial management to achieve success and sustainability. Revenue Cycle Management (RCM) is a fundamental aspect of nearly all types of healthcare organizations, whether it is a hospital, physician clinics, health centers, or rehabilitation centers.

The revenue cycle ensures that the various healthcare providers such as doctors, physicians, surgeons, nurses, therapists, support staff, lab technicians, and social workers are duly compensated for their services. The revenue generation is also needed to pay for medical supplies, equipment, and overheads. The growing population, mostly in urban cities, means that medical practices need to efficiently manage their revenue stream in order to dispense quality care services and financially sustain at the same time.

The Challenges in today’s Healthcare Industry:

In medical business a medical practice has to maintain its quality and accreditation in order to be eligible for reimbursements and loans from insurance companies and third-party payers. Most of the people buy insurance policies that help them to get quick and quality healthcare services in times of need. The medical practice, on the other hand, prepares and sends a ‘medical bill or claim’ to a particular insurance company to collect the reimbursement on the medical procedure or service provided to the patient.

The healthcare costs are increasing, and hospitals have to equip not only modern equipment but also integrate innovative technological systems and solutions to improve healthcare facilities. In times of Coronavirus pandemic, there is significant pressure on the healthcare organizations. The hospitals are finding it quite difficult with the constant rise in cases as the vaccines are still in the testing phase and long from mass production.

The revenue cycle process is one that starts when the patient comes for a visit and finishes when required services are given, the cost of treatment is sent to the insurance company, and payment is collected. The two most essential elements of the revenue cycle are ‘medical billing and coding.’

Medical billing is referred to the processing, submission, and follow-up of the claim, while coding is the process of assigning alphanumeric codes to the type of diagnosis and treatment given to the patient. The claims should be prepared meticulously without any error in coding as the insurance company can easily reject the claim. The rejected claim means the medical practice cannot collect full payment of services, and the healthcare providers cannot be reimbursed properly.

The entire medical and coding process is not easy, and it can be difficult for a medical practice to find and train individuals who can fulfill this crucial task. Busy health centers and hospitals see a constant stream of patients, and providing essential health services has increased exponentially after the Covid-19 outbreak. Now a medical practice has not only treats patients with acute or chronic illness but also take safety measures to treat Coronavirus patients and stop the transfer of the virus.

The medical practices seem to be overburdened and understaffed, and the best solution is to outsource the medical billing and coding process. Outsourcing is not a new concept, and it has done wonders in different business sectors as well. The third-party service providers have designed and developed particular software and systems that can help streamline the billing and coding process.

PETTIGREW is one industrial leader when it comes to offering advanced and innovative billing and coding solutions. The company has a professional group of qualified and capable software developers and billing specialists who help to develop a cutting edge, highly customizable, and cost-effective billing and revenue cycle management software.

PETTIGREW offers a unique solution that can easily be integrated with the health organization’s existing management system, and the necessary features can be selected. The value-added features, such as scheduling, analytics tools, and reporting, can be delivered at a competitive rate. Employing

PETTIGREW medical business services is easy and can be done in three steps, which are

  1. A meeting with a billing expert who will note down the details about the extent of work and needs of particular medical practice
  2. A customized plan is prepared a detailed proposal is submitted for approval
  3. Once accepted, the PETTIGREW team will implement the billing software and train the staff

The Reasons to Implement Medical Billing Software:

Medical billing software is a highly advanced computer application that is built for the purpose of automating the entire billing process of particular medical practice. The key benefit of the software is to streamline the revenue cycle, improve reimbursement rates, help the medical practice to sustain financial health, reduce the time in claims processing and submission, and reduce the risk of rejected claims. The medical billing and coding software is developed to address all the necessary steps of traditional medical billing, from scheduling patient appointments to the delivery of medical services to payment collections. For example

  • The patient details are entered once, and when scheduling an appointment, the front desk staff can see the patient’s insurance eligibility.
  • When a doctor sees the patient, the information can directly be sent from EHR (Electronic Health Record) to Billing software and ensure smooth communication from the front desk staff to nursing or clinical staff.
  • The numerous ICT (International Classification of Diseases) and CPT (Common Procedural Technology) are already added to the software, and with prominent healthcare coding solutions, professionals do not have to recall different and complex codes.
  • The claim forms are presented in a set pattern where any errors or mistakes can be double-checked and prevent any objections or rejection from the insurance companies.
  • As payments are collected in a smooth flow, the analytic tools can be used to generate reports to give valuable insight into the revenue cycle.

According to statistics and research by AMA (American Medical Association), a standard medical practice submits claims from which 50% are filled with minor or major errors and incorrect codes. The inconsistent coding not only accounts for rejected claims but also the process of post-payment audit.

Most of the medical practices use EHR, and it helps to directly transfer the patient details such as his/her medical history, diagnosis, insurance eligibility and plan, and any recommended medical treatment to the medical billing software. The medical coding software is able to scrub claims for errors and validate the ICT/CPT codes and do payer-specific edits. The modern billing software is able to electronically transmit the claims to the numerous payers. The payments are received as Electronic Remittance Advices (ERA) or in hard copy. The reimbursement specialist will review the payment once it’s posted.

The payments are run through payer-specific rules software, which identifies unsettled and unpaid claims. The unpaid claim is flagged, and steps are taken for proper follow-up. Up to 70% of the claims are returned with objections even if the medical practice believes it has sent an error-free claim to the payer.

It’s not a surprise that the payers and insurance companies are always trying to introduce complicated rules and find even minute factors to reject the claim or limit the payment. The medical practice, on the other hand, does not get the required payment for the treatment given to the patient, and the reimbursement to the healthcare providers is affected. The hospital billing software is sophisticated as it alerts the reimbursement specialist to review the history and do follow-up accordingly.

The Advantages of Implementing a Dedicated Billing and Coding Software:

PETTIGREW offers a complete software solution that allows a medical practice to streamline its billing and coding process, improve revenue cycle, and provide enhanced visibility with just the click of a button. There is an added cloud computing service that allows remote work and access to specific performance reports to optimize the financial management of the medical practice. The numerous advantages of medical billing software programs are

  • It effectively bridges the gap between medical practice and an insurance company
  • The traditional way of manual paperwork was time consuming and got complicated with complex codes and more so when the claims came back as rejected
  • The software application validates each code and claim before it is ready to be sent.
  • The patient’s insurance eligibility and status is verified without any hassle
  • The superbills can easily be customized according to a particular doctor or physician
  • The records of every unpaid claim can easily be tracked, and quick follow-ups could be made
  • Payment reminders can be activated to speed up the revenue flow
  • The staff can devote more time to engage with patients and taking care of them
  • The healthcare providers can give full time in diagnosing and treating the patients rather than worrying about filling the patient information
  • The operational costs are lowered, and more financial resources could be spent in catering to the needs of the healthcare providers.

Get More Comprehensive View on Benefits of Outsourcing Medical Billing and Coding

Once a medical practice decides to implement a medical and coding software solution, then the first question arises is the cost of developing a specific software as the needs of every medical practice is different. The claim scrubbing option helps to inspect the claims before submission and helps the medical practice staff to focus on the checklists.

The medical billing and coding software is one platform from where patient claims can be sent to hundreds of different payers and enable fast-tracking and reimbursements. The cost of the billing software depends on Pre-Provider and Pre-Encounter plans. The Pre-Provider plan is best suited for a medical practice with high patient volume, while the Pre-Encounter plan is ideal for a health center with lower patient number such as physical therapy and mental health facility.

The cost increases if the medical practice opts for value-added features such as patient appointment reminders, reporting and analytics, and various online payment options. The fast-changing healthcare industry calls for the use of technology to improve the financial management of the medical organization.

Everyone is susceptible to make a mistake, but the medical profession is one where a little error has far-reaching consequences. One mistake in claim processing can delay the entire payment collection process and disrupt the revenue cycle of the medical practice. Outsourcing the coding and billing solutions will help the medical practice to stay updated with the industry standards and provide the best service to the patients.