2021 HME Business Handbook: Strategy

How Outsourcing Has Dominated the HME Billing Market In 2021

What economic factors related to billing are eating up your revenue, and how do you act to take back control of your bottom line?

Outsourced medical billing is exploding. Today the global medical billing outsourcing market is expected to grow to $9.528 billion from $8.415 billion at a compound annual growth rate (CAGR) of 13.2 percent in 2021. And the pandemic has only furthered outsourcing’s growth.

In fact, about ninety percent of healthcare leaders are considering outsourcing in both clinical and non-clinical functions to achieve cost-efficiencies and succeed in value-based care models due to the challenges healthcare practices and their CFOs face in budgeting.

Moreover, the rising labor cost with each year typically ends up with more than half of a healthcare practice’s operating revenue, leaving them to rethink the role of in-house billers and coding staff.

Furthermore, in 2020, the healthcare segment has been held as the highest revenue share of 47.2 percent in the medical billing outsourcing market for being the prime users of outsourcing services due to high claim volume. Reprocessing claims drives up costs as billing staff must dedicate more time to unpaid claims.

However, given that economic reality, providers should explore opportunities to simplify and streamline a complex organization, and outsourcing is the best cost-effective solution so far.

Outsourcing your HME billing operation or any other medical billing specialties to a third-party RCM solution can not only help you determine the right balance of automation and technology but also help your practice focus more on patient care.

Also, the right operational extension can help your provider business overcome the challenges of disparate EHR and systems to optimize revenue cycle management without costly technology fixes and integrations. The question is how to choose the perfect RCM?

PRO-TIPS: CHOOSING THE IDEAL RCM SOLUTION

  • HIPAA compliance — A complete HIPAA compliance should be on your top priority list while choosing the operation extension for your billing management. As in the exchange of data during the billing operation process, it is quite essential to safeguard the privacy of people and their information. Also, the data needs to secure in order to avoid fraud and laundering of unnecessary information and money.
  • A strong front and back end support team — A seamless and efficient billing operation is the key to better reimbursement. An HME business should always look for an experienced team handling their billing operation who are also experts that completely understand insurance, payers requirements, changing billing mandates, new codes, etc.
  • An RCM that ensures the highest productivity metrics — An RCM solution that helps you eliminate all the unnecessary costs while decreasing the overall operational expense is a must, as it not only helps the practice earn more but assists them to invest further to make the patient life and treatment process adequate. Furthermore, an RCM solution with the highest productivity metrics also ensures lesser backlogs or lost revenue which is also key towards a thriving billing operation.
  • Excellent standard of communication and reporting — In order to decrease the gaps in between your HME billing and coding process, excellent communication and customized based reporting is essential as it plays the key ingredient that aids in reducing your DOS, billing errors, denial, and claims rejection.
  • Helps you with better patient care management — Improving your key performance indicators (KPIs) such as data and coding accuracy, reduced denial rates and improvement in DSO along with timely appeals, etc., RCM that helps to focus on the patient care/clinical side of the business is equally important.
  • Excellent industry references — An industry reference not only helps you get the feedback of the work that you will receive when you opt for the services from the RCM operational extension but also gives you the idea if the operational extension is worth the try and you are not wasting your money.

Today, there are numerous outsourcing RCM solutions that are cost-effective and better than in-house billing. This can save your business from wasting time on technology investments, software, and staff. At Sunknowledge Services Inc., we have reduced 80 percent of clients’ operational costs and helped them with seamless billing operations and a better cash flow.

POINTS TO REMEMBER

  • Medical billing trends for 2021 stated that the medical billing outsourcing industry will touch nearly $16.9 billion.
  • Outsourcing RCM helps healthcare organizations improve KPIs in this era of rising healthcare costs and administrative burden.
  • Many companies have adopted offshore business strategies directly or indirectly as it has been better and cost-effective.
  • Key players in the outsourcing market who are ruling can save you considerable overhead while driving increased revenues.

LEARN MORE

To read more about management and operations strategies, visit hme-business.com/management. To learn more on improving your billing operations and productivity metrics, check out Sunknowledge Services Inc.’s RCM solutions at sunknowledge.com.

This article originally appeared in the May/June 2021 issue of HME Business.

About the Author

Ronnie Hastings ( Assistant General Manager) brings to the table more than 15 years of professional experience. He has handled major initiatives in contact center operations, relationship management and sales. At Sunknowledge, he started working with Part C and Part D and effective coordination with the private healthcare. Over the last 10 years, he has been a successful mentor and evolved as a promising resource for the company. At present, Ronnie is a pioneer member of Sunknowledge’s strategic think tank and is heading responsibilities in marketing, business development, and account management. He is also a seasoned expert in telemedicine services. He can be reached at Ronnie.Hastings@sunknowledge.com.

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