How to Outsource Insurance Follow-up to Improve Financial Performance

Our medical practice has in-house billing and doesn’t want to hire a full-service medical billing company. But we do want to improve our medical billing process. What can we do?

 

            Many medical practices face some variety of this situation:

  • Maybe you’re a multi-location practice with a large billing department, and the prospect of transitioning to a medical billing company is too complicated to even contemplate.

  • Maybe you love your in-house billing staff but they’re overwhelmed and financial performance is suffering.

  • Maybe your billing staff also performs some non-billing functions and disentangling billing and non-billing tasks would have repercussions in other areas of the practice.

 

In situations like these, hiring a full-service medical billing company may not be the right solution for your practice.  But while there may be multiple areas where your billing process is under-performing, it’s a good bet that the area causing the most problems is the Insurance Follow-up Process.

 

What is Insurance Follow-up and why is it such a problem?

It would be wonderful if insurance companies always sent clear and accurate explanations for why they denied a claim. Unfortunately, for a meaningful percentage of claims, that doesn’t happen. Denial reasons are ambiguous, obviously wrong, or simply missing. And in many cases, the practice may not receive information about the denial at all.

Insurance Follow-up is the process of calling insurance companies to get detailed information on why they denied a claim so that you can correct the errors, resubmit the claim and get paid. This process is the weak link of almost any billing operation:

  • It’s incredibly time-consuming;

  • It requires unwavering focus and organizational skills;

  • It requires deep and extensive billing expertise.

It’s also the billing task that most frequently drops to the bottom of the priority list.  After all, if it takes an hour to either enter 40 new charges or call an insurance carrier and follow-up on 5 claim denials, it makes good financial sense to get those 40 charges into the system first.

But over time, those 5 claim denials become 10, or 20, or 50 denials, and now the time and effort required to address them are so significant that nobody has time to do it properly.  Staff gets to the claims when they can, but the follow-up hole gets deeper and deeper, more and more claims aren’t paying, and the financial performance of the practice suffers. If your practice is in this situation and you don’t want to hire a medical billing company to handle the entire billing process, you can instead outsource the Insurance Follow-up process. 

 

 

How to Outsource Insurance Follow-up:

           Insurance follow-up is a sufficiently discrete task that it can be detached from the rest of the billing process without too much difficulty.  Here’s how to do it:

  • Find and hire a company that offers insurance follow-up services on an hourly basis.

  • Give them an unpaid claims report from your billing software. They’ll spend the required hours on the phone and internet researching and resolving claim denials.

  • If they can’t resolve the issue and get the claim paid themselves, they’ll provide clear guidance to your billing staff on how to get the claim paid.

When the practice outsources time-consuming insurance follow-up, your internal staff can get problem-claims paid while spending a fraction of the time and effort otherwise required. They’ll have more time to spend on other important tasks. And, most important, as these problem-claims finally start paying, more money will flow to the practice. 

 

 

Advantages and Challenges of Outsourcing Insurance Follow-up

Most insurance follow-up companies are based off-shore, particularly in India.  Ten or fifteen years ago, hiring an offshore company was available only to the largest companies. Now, it’s an option for companies of any size, including medical practices. Offshore outsourcing offers some powerful advantages:

  • Lower costs compared to US staff;

  • Good work ethic and a strong commitment to their assigned tasks;

  • Steady and efficient productivity.

Working with an offshore company also presents some challenges that, if not properly handled, can reduce their performance and require extra time and work by the practice:

  • Cultural and language disconnects that can make communications inefficient and time-consuming;

  • As outsiders to your practice, they need extra managerial guidance to ensure fidelity to the rules and processes of your billing operations;

  • Practice management must carefully allocate billing tasks between offshore and in-house staff so each staff member does what he or she does best.

Addressing these challenges requires some effort and some thoughtful personnel management. But investing that time and effort can pay significant dividends in improved financial performance and billing efficiency. And for practices that are already deep in the “follow-up hole”, outsourcing to an insurance follow-up specialty company is usually the best, and sometimes the only, option.

 

 

If you’d like more information on how to select an offshore medical billing partner, please see our blog post: How to Interview and Select an Offshore Partner for Insurance Follow-up – a Step by Step Guide.   

 

If you’re interested in outsourcing Insurance Follow-up but are concerned about the time and effort involved, please contact us directly at info@emedpartners.com. As an American company with offshore staff, we handle the challenges of outsourcing so that our clients can reap the benefits. We exist to make outsourcing easy.

Rusty Wilson is the founder and principal of eMed Partners, a full-service medical billing company for physicians and medical practices.
For more about our billing services: http://emedpartners.com/
To follow Rusty on LinkedIn: https://www.linkedin.com/in/rusty-wilson-520206/

Mike Moll