Hospital Billing Outsource

Written by Kimberly Clark
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Because of the increasing complexity in preparing and submitting healthcare claims, several hospital billing departments are opting to outsource a large portion of their workload to medical billing companies. The hospitals seem to perform well when it comes to submitting claims for facility-only related services, but seem to have some degree of difficulty collecting for other professional services performed at the hospital, which have to be itemized and then invoiced separately.

Billing for services performed by hospital-based specialist (or hospitalist), such as emergency room doctors, anesthesiologists and radiologists, is a very cumbersome task. Every line item listed on the claims must be individually evaluated for approval. The process is compounded by the healthcare plans and insurance companies randomly changing the procedures for obtaining reimbursement.

In addition, the federal and local regulations governing healthcare claims are also constantly changing. Getting the total invoice paid often involves several iterations back and forth with the payer companies. Thus, in an effort to save time and money, many hospitals contract outside billing companies to submit and collect on their hospitalist's claims.

What to Look for in a Hospital Billing Company

When outsourcing to a hospital billing company, there are several things a hospital needs to look for. The hospital will obviously want to make sure it understands what the billing company charges for its services. Most healthcare billing companies retain a percentage of the fees they collected, which is generally around five to 10 percent.

A hospital may instead elect to invest in a one-time software upgrade. The right software program can integrate all facets of billing, while keeping detailed records, in order to allow hospitals to keep the focus on patient care. The software should be able to integrate billing needs, claims needs, and management functions with detailed reports and services.

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