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December 1, 2022

Pros and Cons of Outsourcing ASC Medical Billing

Dr. J is a Physician, MBA graduate, AAPC Certified Coder (COC), and ASQ Certified Six Sigma Black Belt (ASQ CSSBB) with 20+ years of experience in the Healthcare Industry. His key expertise areas include coding in multiple specialties, end-to-end RCM, multiple market segments, product and process innovation for the healthcare business, lean six sigma management, and process design and improvement.

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More than 50% of ASCs think medical billing is complicated and are often overwhelmed by the constantly changing rules and regulations. Payers have started demanding more from ASCs to accompany the submitted claims. Medical billers need better dashboards, easier reporting customizations, more virtual tools, enhanced ability to understand key billing metrics, and more.

ASCs have to be on their toes to track all the changes in compliance and regulatory guidelines that are specific to them, as a slight error can cost thousands of dollars and can increase the risk of external audits. Even insurance companies keep updating their platforms and are regularly changing their methodologies.

Medical billing companies are constantly updated with the latest tools and software to assist ASCs in billing and ensure maximum reimbursements. As a result, most ASCs prefer to outsource their medical billing to avoid all the complex nuances surrounding getting reimbursed for their valuable services. This blog will discuss the Pros and Cons of outsourcing medical billing and whether you should partner with medical billing service providers for your ASC.

What exactly is outsourcing ASC billing mean?

ASC billing translates all the services, records, and treatments offered to the patients into a systematic format that insurance payers can understand. ASCs get paid only if all the information is appropriately updated and documented according to the payer's guidelines. ASC billing process is complex and full of jargon that only a certified and experienced professional can understand. The slightest errors while submitting the documents or updating the patient treatment information result in a partial payment or complete claim denial.

ASCs, initially handled all the billing in-house with their staff. It was and presently is a tedious process with lots of documentation and jargon that takes an immense amount of time to understand and be able to perform. It also demands a lot of paperwork. Due to the advancement of technology and increase in awareness, ASCs have started partnering with firms that provide end-to-end RCM services. Outsourcing ASC billing services means that the ASC no longer has to worry or stress over the complexities within the processes surrounding getting reimbursed for their services from the insurance companies because that burden now falls under the RCM vendor that the ASC chooses to handle the ASCs medical billing services. ASC billing service providers offer exceptional services as they have a big team of experienced and certified professionals who work rigorously to get full reimbursement for the ASCs. They use cutting-edge technologies, which adds more value to the billing and helps to streamline the RCM processes for ASCs.

Pros and cons of outsourcing ASC medical billing    

Benefits of outsourcing ASC medical billing include:

Swift insurance payment

Reduction in medical billing errors results in faster payments and complete reimbursement. ASC medical billing service providers use a combination of advanced technology and experience to submit, track, and manage claims.

Outsourcing with a reputable ASC billing firm like Plutus Health can increase revenue, simplify workflow, and bring exponential growth for an ASC.

Reduced costs

Hiring and maintaining in-house medical billing is a massive cost for ASCs as it comes with overhead expenses like payroll, infrastructure, onboarding, insurance, and more. These costs can be reduced by outsourcing medical billing services. ASCs do not have disposable income or the time required to maintain an entire department of in-house billers. They can't find a quick solution if a key employee plans to quit or just walk out. By outsourcing ASC billing to Plutus Health, ASCs can count on us to manage all their billing needs, including staffing requirements, at a lower cost.

Complete transparency

Some ASCs consider outsourcing is like transferring complete control and decision-making power to an external company. However, this is not correct. When ASCs partner with a third-party medical billing service provider, the outsourced medical billing provider company is held responsible for and accountable for providing positive results based on pre-decided parameters before signing the contract. ASCs can look at key performance indicators called KPIs to evaluate the outsourced billing vendor: clean claim ration, denial rates, and first-pass ratio to evaluate results. Choose an ASC medical billing provider who offers results backed by data and one that agree to provide complete transparency into the RCM processes and revenue cash flow. Plutus Health regularly generates reports based on KPIs and shares them with its clients. Plutus Health's billing staff illuminates post-payment concerns and delays to better understand and improve the financial performance for their clients.

Eliminate errors

ASC billing has stringent rules that are difficult to manage and understand. A small error, one necessary item that is missing, a word out of place, or a scrubbed item, can unnecessarily cause long delays in reimbursements and can even cause a complete denial. ASCs must execute the complete RCM processes from the beginning to the end without errors. Sometimes, errors occur at the final submission stage when all the documents must be electronically sent. 90% of the errors in ASC billing are caused by human errors. Plutus Health leverages software and AI to augment, support, and oversee the complete billing processes to dramatically reduce errors and eliminate all unnecessary and/or careless errors. Plutus Health does all the quality benchmarks without putting pressure on ASCs.

Better patient satisfaction and care

ASCs always aim to provide their patients with the best quality care and services. When an ASC has to perform and manage its RCM processes, it is difficult for the ASC to focus on patients and meet their expectations completely. Managing RCM and Clinical functions will overstress the ASC's in-house staff. Over-stressed staff that doesn't have enough time to deal with RCM processes and to effectively deal with the patients clinical flow properly will not perform as well in key patient flow areas like dealing with patient appointments, managing patient check-in and check-out, and/or handling clinical concerns. Outsourcing ASC billing to Plutus Health enables ASCs to divert all the billing stress to experienced billers and free their staff from all the complex RCM activities. ASCs can concentrate on patients and can work to provide better services to them, leading to higher patient satisfaction and retention rate.

Cons of outsourcing ASC medical billing

The most significant disadvantage of outsourcing ASC medical billing providers that cannot be avoided is cost. Outsourcing always has a cost that might affect the bottom line of an ASC. Each firm has its way of charging its required fees.

When ASCs partner with Plutus Health, they do not have to worry about high costs. ASCs need to pay only after they are paid. We provide exceptional ASC medical billing and RCM services to the ASCs. Are you looking to outsource ASC billing services? Connect with our experts to know how we can provide you with our valuable billing services.

Key Takeaways:

  • ASC medical billing is overwhelming, and the slightest mistake here affects the bottom line.
  • Outsourcing reduces errors, increases revenue, and decreases operational costs.
  • Patient satisfaction and retention can be achieved with outsourcing your medical billing.  
  • Tech-enabled ASC billing services increase transparency without giving away the power of decision-making.

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Dr. Jagadeesha. G. S

Dr. J is a Physician, MBA graduate, AAPC Certified Coder (COC), and ASQ Certified Six Sigma Black Belt (ASQ CSSBB) with 20+ years of experience in the Healthcare Industry. His key expertise areas include coding in multiple specialties, end-to-end RCM, multiple market segments, product and process innovation for the healthcare business, lean six sigma management, and process design and improvement.

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