When it comes to seeing more revenue, few things are as in your control as improving your billing process. This is money that’s already yours. Most clinics have opportunities to recoup more with the right processes, expertise, and insight.
But one question that always comes up is whether it makes more financial sense to take on these improvements with in-house billing or to outsource to a team of experts. This is a valid concern for urgent cares of all sizes.
We sat down with our own RCM (revenue cycle management) experts to dive into the most important factors to consider for in-house vs. outsourced medical billing — along with some valuable tips for success if in-house billing best for you.
Much of your decision to keep billing in house depends on the size and quality of the staff you can assign to these tasks. Here are some of the most important considerations.
If you only have (or need) one or two people to take care of your billing, consider what happens if one of them quits or otherwise leaves abruptly. If that was the only person who knew how to do things, where everything is, how to report, and how to interpret reports, you’re going to be in a giant bind without them. If they’re one of two, that still means you lost 50 percent of your resources dedicated to billing. Even larger companies that perhaps have five people on billing, losing 20 percent of resources can stretch people thin and open you up to more mistakes and less follow-through on collections.
Outsourcing eliminates this problem completely. You’ll always have an expert who can give you the information you need and will never slow down on making sure you recoup as much revenue as possible.
Tip: If you do in-house billing, it’s important to protect yourself against a situation like this. Make sure that you or someone else who is as committed to your business stays up to date on processes, files, reports, and everything else they would need to know to step in and help.
If your billing staff has duties outside the rev cycle, you could be opening yourself up to delays, mistakes, and even neglect. People tend to procrastinate the duties they don’t enjoy, and few people really like the billing process. So competing projects, people, and other distractions continually move billing down their priorities. By the time they get to their RCM responsibilities, they may be hurried, exhausted, or resentful — which makes it far less likely they will follow up on collections and far more likely they will make mistakes that lead to denials, rejections, or under coding.
Obviously, outsourcing removes this concern, and you can always rest easy that your billing partner consistently works to make sure your billing is as pristine as possible.
Tip: In this labor market, it’s tough enough to get people to do billing, no matter what size business you are. Do what you can to help minimize their distractions so that they can have the energy and patience to do that job well.
As we cover in our next section, there is a lot to keep up with to always ensure that coding is accurate and you’re compliant. And that’s on top of the other general knowledge your staff will need to execute the billing process. If the person/people handling your RCM are not very good at it, do not like it, or don’t have time to stay educated on current coding and regulations, it’s highly likely you’re losing money.
Of course, outsourcing means that you have a team of people not only trained in RCM through a tested program, but who are also using well-defined policies, procedures, and best practices that ensure your RCM is being optimized. When changes occur, like to coding, this team knows those changes.
However, if you’ve recently spent time and money to train your billing staff, that cost is sunk if you switch to outsourcing. This could be more immediately significant to your bottom line than the increase in revenue you gain over time with a third-party biller.
Tip: If outsourcing is appealing to you, but you don’t want to flush your training costs, think about when it’s time to retrain, and use the interim to research the best vendors to contact at that time.
On 1/1/21, major coding changes happened for the first time in 25 years. How long did it take you to learn and switch to this? Getting this foundational piece of RCM wrong could cost you not only dollars, but business disruptions and your reputation.
In fact, compliance in general is critical to your billing. You cannot afford to have anyone who doesn’t understand this working your RCM. The best control you could have over this is using a third-party biller. Your outsourced partner is committed to compliance and will assist you in making sure you are doing things in a compliant manner.
Even when your staff is well-educated on billing and coding, there’s another common scenario in urgent care that hurts your bottom line. Providers can typically handle complex, devastating medical situations. Because of that, they may mistakenly miscode based on their own perception of the severity of the situation.
For example, a provider may feel that a sinus infection is really simple, and code based solely on that — consequently, they miss the true level of complexity associated with antibiotics or other risks of developing morbidities. You might not catch this, but an outsourced billing partner will.
Tip: For in-house billing, make sure you routinely train both billing staff and providers on coding and compliance.
Generally speaking, outsourcing your billing means a higher percentage of your claims will be paid at a higher amount. That’s because a dedicated billing company sends claims more thoroughly, reliably, and quickly than an in-house billing team. But since you have to pay them, when does it become less expensive and more profitable to do so?
You pay an RCM company on a percentage based on how much they collect. More patient visits mean more billing, which means more collections. If you rely on staff, your costs (their salary, benefits, etc.) stay the same no matter what. If you have an EXCELLENT in-house billing team, and you have a high number of visits each month, it could cost you less to keep that staff.
However, if you have a month where you see 400 patients, and another where you have 1,000, those 400 patients cost you the same with in-house staff, whereas it costs far less than a volume of 1,000 with a billing vendor.
Tip: If your visit volume is consistently high enough to justify in-house costs, do everything you can to make them masters of their work, especially when it comes to follow-up as explained in the next chapter.
The absolute biggest miss our RCM experts see in urgent care billing is lack of follow-up. Staff sends charges and posts cash, but then is not diligent about following up on collections. This is 60 percent of your billing and also where you’re probably losing the most money. Plain and simple: your chances of collecting are greatly reduced without proper follow-up from staff.
The ideal collection rate in the industry is around 96 percent. Most clinics have a rate between 75 percent and 85 percent, which means that an outsourced billing company can not only improve your collection rate, but also your save staff from timely rework. The average collection rate (
Just because this is a short section does not mean you should ignore it. The fastest, most impactful way to improve your collection rate and raise revenue is to address follow-up!
TIP: Again, make sure to limit the distractions of your internal billing team, but also provide training and a script to help them be successful at following up with collections.
This is one of the topmost reasons urgent care clinics want their medical billing in-house: maintaining full control. The idea that you surrender control with outsourced billing is generally false. It’s only really a relevant concern if you’re someone who wants to check in on every minor detail or every one, two, or ten dollars you expect to receive.
Consider where this may hurt you, though. If you become fixated on one visit that didn’t go your way out of several hundred that did, how much time are you spending on this that you could use to connect with businesses and your community to increase visits? You need between 500 and 1,000 visits a month for healthy revenue.
Outside of that, let’s cover some reasons you are in control of your billing with a third party, and also what it looks like to have control over your billing in-house.
The other chapters speak to ways you have control over billing when you outsource, like having a team who is current on and committed to compliance, best practices, and making you look good. A few other points to consider are:
No matter whom you choose to do your billing, what does it look like to be in control of this? Here is a quick overview of what this entails.
No matter who you are, you can easily get an accurate understanding of the sate of your rev cycle and see where you have the most opportunities to improve — for FREE.
Experity’s RCM team has conducted hundreds of free billing analyses that help urgent care businesses:
Take advantage of this free, no-obligation service by signing up through this link:
If you’re considering outsourcing, this is not a decision to rush into. There are a lot of companies out there, and if you’re in urgent care, your research can take more time than it would other medical practices. That’s because, generally speaking, most medical billers don’t have as much expertise with urgent care as they do other disciplines. Also, because urgent care claims are generally smaller, your business doesn’t make them as much money as their other clients, which unfortunately can mean your claims don’t have the same priority.
That won’t always be the case — you should ask trusted colleagues what vendors they use and what feedback they have on that company’s performance.
You can also use a company that only focuses on urgent care, so you know that the nuances of the industry are well understood and that you’re always a priority no matter what your clinic brings in financially.
Experity deeply knows this marketplace, and all our resources are directly focused on urgent care — so when something like a pandemic happens, we’re on top of changes that impact your RCM. We catch things other companies may not because this is all we do.
Before picking Experity, I researched a ton of EMRs. It came down to what Experity offers and how I have a team behind me. I am convinced, had I not used them from the beginning, I would not have seven urgent cares in five years.