With healthcare regulations becoming stricter and medical billing standards becoming more complicated, it has become complicated for healthcare providers to manage their tasks efficiently. With more practitioners, trying to figure out what to choose between in-house and outsourced laboratory billing services considering the pricepoint and value addition by both solutions, it’s essential to consult with a professional lab billing company.
In-house Laboratory Billing Services:
When healthcare providers hire medical billers and coders in their office to proceed with billing tasks, submit medical claims, and collect reimbursements then this system is called in-house laboratory billing services.
For this purpose, practice owners have to invest a capital amount to set up an IT infrastructure for individual employees, buy & maintain medical billing software, buy office stationery, and incentives.
Moreover, practice owners have to constantly pay their employees monthly salaries, annual bonuses/ appraisals, paid leaves, holidays, and insurance coverage (as an incentive).
In-house lab billing services are suitable for small-sized medical labs where providers can hire 1 or 2 medical billers and assist them in billing tasks. However, large-sized medical practices may find it challenging to hire and maintain and in-house medical billing team.
For further details, let’s probe into the potential benefits and challenges of in-house lab billing services;
Pros Of In-House Laboratory Billing Services:
Control and Oversight:
It is the most significant benefit of in-house lab billing services that it gives you better insights and control over your billing tasks. Although, in a small-sized medical practice it might seems like a good option. However, in a large-sized practice like hospitals, healthcare providers have so much on their plate already that they can’t micromanage every other task.
Customization:
For in-house billing services, healthcare providers can guide their office team how to create tailor-made process to execute billing and coding tasks to meet the specific needs of your practice. When a medical billing team provides customized lab billing solutions then you can reduce your work-stress and focus on delivering better patient experience.
Data Security:
Keeping in-house laboratory billing services provides you better control over patient data security. In this way, you can easily ensure compliance with healthcare privacy regulations like HIPAA. In this way, it minizes the risk of data breaches and unauthorized access. However, buying expensive IT setup and security tools to ensure well-encrypted communication across the practice can’t be the primary choice for most of the practices.
Improved Communication:
In-house lab billing services allows healthcare providers to easily communicate with the team members and administration staff. This streamlined communication can lead to efficient issue resolution and smooth workflow.
Quality Control:
It’s easier for healthcare providers to maintain and train an in-house team for laboratory billing services. In this way, practice owners can acquaint their staff with the facility’s policies and procedures. In this way, your medical billing staff can comply with your practice’s policies and encounter few errors in billing and coding.
Flexibility:
It’s easier for healthcare facilities to adopt ever-changing billing and coding rules and swiftly tune the practice management system with the help of an in-house medical billing team.
Patient Relations:
If patients have urgent quries about their bills and coverage then an in-house billing team can help healthcare providers encounter such concerns of the patients right away. In this way, it helps healthcare providers to ensure patient satisfaction and higher patient retention rate.
However, for a large-sized practice, it’ll be much difficult for practitioners to solely stay in touch with a huge billing team and large volume of patients. Therefore, they always need assistance of customer support team to build a meaningful relationship between the patients and the healthcare facility.
In this way, providers would have to create two team i.e. medical billing specialists and customer support professionals to work on this area of their practice’s revenue cycle management. Therefore, its better to pay a fixed amount to a third-party lab billing company to handle all these tasks once and for all.
Efficient Reporting:
In-house lab billing teams can generate accurate and customized reports according to the practice’s requirements. For example, if a healthcare provider wants to judge the payment behavior of a specific insurance carrier then he can ask his employees to generate a customized report.
In this way, providers can get valuable insights with efficient and customized reporting which helps in financial planning and decision-making.
Long-Term Sustainability:
In-house lab billing services are more sustainable for a small-sized practice in the long term. Because they can manage their billing operations in their office premises, ensuring smooth execution of healthcare revenue cycle management.
While in-house laboratory billing services have their advantages, they also come with some potential disadvantages and challenges that healthcare providers should consider:
Cons Of In-House Laboratory Billing Services:
Resource Intensive:
It is a difficult task for a medium-sized healthcare lab to establish and maintain an in-house medical billing department. Because it will increase a burden on their budget and team to recruit and hire professional lab billing specialists.
Usually, kids after their high-school start working as medical billers and coders. Although, there are college degree programs for learning medical billing and coding. However, most healthcare providers hire and recruit fresh graduates and train them for lab billing services. It helps them hire resources at cheap cost than industry standard salaries of professional and experienced lab billing specialists.
Therefore, it can also become an expensive solution for those healthcare providers who want to hire professional and well-experience lab billing and coding specialists to manage their billing tasks.
Expertise and Training:
For an in-house lab billing team, healthcare providers can their resources for ever-changing billing standards and coding regulations. With the help of an office-based team, providers can also tune their practice operations in order to comply with evolving coding and billing environment.
However, managing your healthcare lab and keeping an eye on every update in the billing laws is an intimidating burden of responsibilities.
Delivering quality laboratory billing services is complex and subject to regulatory changes. In-house billing staff must be continuously trained to stay up-to-date with evolving billing codes and regulations, which can be time-consuming and costly.
Limited Scalability:
In-house lab billing team may struggle to scale the new changes and updates in regulations and coding practices efficiently with the growth of a healthcare facility due to the limited number of resources. Hiring and training new staff can to bottlenecks and increased backlogs which may eventually impact your revenue growth.
Costs and Overhead:
While working with an in-house lab billing team can be cost-effective in the long run, it can initially involve high setup costs and overhead expenses. Moreover, maintaining huge headcount and ensuring long-term retention can strain your practice’s budget.
What Is Outsourcing Laboratory Billing Services?
When a medical lab gets connected with a third party to get assistance with billing and coding tasks then it is called outsourcing lab billing services. For this purpose, medical labs find a reliable lab medical billing company near their practices that can provide lab billing services in compliance with their state laws.
A professional lab billing company collects requirements and informations from healthcare providers and meet the staffing needs to accomplish their billing and coding tasks for efficient growth.
It is a good option for medium and large-sized healthcare facilities like hospitals and healthcare organizations to outsource laboratory billing services. In this way, they don’t have to conduct a time consuming research to hire the best experienced and professional lab medical billers and coders.
After outsourcing lab billing services, it becomes the responsibility of the lab billing company to provide resources to manage your practice healthcare revenue cycle management. Unlike an in-house billing team, you don’t have to worry about the backlog created by absent or resigning employee. Because the lab billing company stays available to manage your billing tasks according to the days and timing agreed upon by the both parties (healthcare providers and the lab billing company) in the agreement contract.
Moreover, medical billing companies usually charge a fixed amount/percentage in the three following ways;
What Are The Different Types Of Payment Models Of Lab Medical Billing Companies?
- Percentage-based:
In this model, a lab billing company only charge a fixed percentage of the total collections that are received by the medical billing company on behalf of your practice. This percentage typically ranges from 2% to 10% depending upon your practice’s size.
- Fee-for-service:
In this model, a medical billing company charges a fixed fee for the laboratory billing services they deliver. They may standardize their fees on a per-claim basis or a monthly basis charges. It also depends upon your practice’s size and the complexity of the billing services provided the company.
- Hybrid Model:
This model combines the essence of both the percentage of collections and flat fee model. The lab billing company charges a flat for basic billing services such as claim preparation, submission, and following up with claims. Also, it includes some elements of the percentage model for more complex services such as appeals and denial management.
- Hourly Rate:
This payment model is simple and it makes the medical billing company charge a fixed hourly rate for their billing and coding services. This hourly fees varies across several medical billing companies depending upon their practice’s size.
Now, we’ve learned that you don’t have to buy and set up an expensive IT infrastructure for an outsourcing lab billing company. Neither do you have to stress about employee retention and resource maintenance. Since it is the responsibility of the lab billing company to meet the growing needs of your business and ensure the smooth execution of your billing tasks.
However, it also offers some limitations because it might be an expensive option for a small-sized practice to outsource lab billing services;
Pros Of Outsourcing Laboratory Billing Services
Cost Savings:
Outsourcing often proves to be a cost-effective lab billing solution because it eliminates the need for hiring and recruiting in-house professional lab billing and coding specialists. You jst have to pay a fixed/percentage to the lab billing company and they will fulfill your staffing needs at the fraction of your existing administration expenses. You can also save costoverageas on software and infrastructure expenses.
Expertise and Experience:
Lab billing companies specialize in delivering on-demand medical billing and coding services to healthcare labs. Therefore, they have the required expertise and potential to understand the unique requirements of your practice and deliver customized services.
Unlike amateur medical billers and healthcare providers, lab billing companies have the required expertise and experience for medical billing and healthcare revenue cycle management.
They are the subject-matter experts and their companies run by generating more and more revenue for healthcare providers. Therefore, they have the urge and training to understand the complexities of healthcare billing, ensuring accurate coding and reduced claim denials.
Reduced Administrative Burden:
By outsourcing lab billing services, healthcare providers can entirely focus on the main objective of their practice i.e. providing satisfactory patient experience.
It enables healthcare providers to reduce administrative work stress of healthcare providers and help focus more on delivering quality patient care services.
Latest Technology:
Lab billing companies invest in advanced medical billing and software technology. Therefore, you don’t have to subscribe to any medical billing software for every team member in the medical billing team.
In this way, you can ensure efficient claim processing, quick reimbursements, and compliance with industry standards and regulations at cost-effective prices.
Faster Reimbursement:
Professional lab billing companies often have established relationships with insurance payers and understand their billing requirements. Therefore, they also help healthcare providers to build a profound relationship with insurance companies.
It results in quicker reimbursement turnaround times helping you boost your business productivity efficiently.
Staying Current:
Since lab billing companies are only concerned with the billing industry, therefore, they’re always monitoring the changes in healthcare regulations and coding requirements. In this way, you can have a professional team onboard who can help everytime when there is an update in the billing rules or coding standards.
In this way, you can stay compliant with regulations and ensure accuracy in medical billing and coding.
Outsourcing lab billing services offers healthcare providers professional insights, expertise and experienced team members at the more cost-effective price. In this way, healthcare providers can increase their cost savings and cut short on their office expenses. Also, they can enjoy the freedom to spend more time with patients and provide them with better care services.
However, let’s see if there are any limitations to outsourcing lab billing services;
Cons Of Laboratory Billing Services:
Loss of Control:
When you outsource lab billing services then you don’t need to micromanage every team member in the billing department. A lab billing company will be working on your practice’s healthcare revenue cycle management as a virtual extension of your administration from a remote location. Therefore, you won’t have a very close sight over your billing operations.
However, there are several professional medical billing companies like CureCloudMD that provide highly transparent lab billing services. Such companies offer providers regular performance reports so you can get real-time insights into your billing operations and reimbursement collections.
Privacy Concerns:
Sharing patient data with an external medical billing company also raises privacy and security concerns. Therefore, you should prefer looking for medical billing agencies that ensure HIPAA compliance.
You can ask them about their HIPAA training certification and how they ensure data security and encryption.
Cost Considerations:
It is important to consider a medical billing company on the basis of pricepoint. Although, a medical billing company offering lower or higher charges doesn’t mean it also qualifies for better quality lab billing services.
However, it may help you identify the value-based contribution of a medical billing company is comparable with the prices.
