As an OB/GYN, you’re passionate about your work. You take pride in the positive impact you have on your patients’ lives and well-being every day.
But you’ve also got to run a business, which means wrestling with how to bill patients and insurers for services rendered in the most effective way possible. Obstetrics and gynecology medical billing presents unique challenges that are more complex, more labor-intensive than ever before, thanks in large part to its ever-changing nature. The government is more involved, and increasingly, the practice of medicine is overseen by those who don’t even hold medical degrees.
Who should perform the billing function for your practice? Is it more cost-effective to do all of it in-house, or should you consider outsourcing? Here are some questions that might help you make that decision.
#1: Do You Have The Appropriate Staff In Place?
If we’re being realistic, the process of billing for medical services has become so complex and so technical, it should only be done by highly trained, detail-oriented and experienced professionals. This is especially true for OB/GYN billing. It is more than simple data entry. Even the smallest of errors on insurance claims can cause an insurer to delay processing or deny a claim outright, so meticulousness and the ability to focus are key to your practice’s success.
If you hope to bill in-house, you’ll need an internal medical biller and support staff well-versed in CPT and ICD-10 medical coding protocol. They’ll also need to be familiar with the most current federal, state, and local regulations and compliance standards regarding the billing process. Your team should be able to analyze data and retrieve and apply codes quickly and efficiently without sacrificing precision. You will also probably need medical billing software in order to properly execute revenue cycle management.
You’ll also need to invest in continuing professional education programs to ensure your staff is up to date with the most recent legislation.
Your staff needs to be expert in the mechanics of Medicare, Medicaid, private and public insurance plans in order to address in-network and out-of-network scenarios. They’ll need to understand the difference between global and technical billing, which is especially important for OB/GYN providers.
It does no good to have a knowledgeable billing team if they’re not accurate and conscientious. Duplicate claims, cash payment discount policy errors and misspellings all can have a negative effect on cash flow and profitability.
Often, the task of explaining complicated insurance company rules to patients defaults to office staff, so ideally, you’ll want a billing team capable of answering questions about coverage during a calendar year, deductible obligations, pre-existing conditions, preventative qualifications, and other insurance billing-related issues.
Are You Willing To Be Fanatical About Compliance and Regulation?
You’ll need to be If you’re going to have an in-house staff perform medical billing functions for your practice. It’s important that you and your staff are up to speed on the very latest, ever-changing regulations.
The Patient Protection and Affordable Care Act of 2010, for example, has rolled out various requirements over a period of years since it was adopted, with additional rollouts scheduled for 2020— and that’s not including additional changes that have been made via executive order since 2017.
To serve Medicare and Medicaid patients, billing experts must know and understand Centers for Medicare and Medicaid Services policies and comply with them, regardless of how many or how few or your patients actually carry these plans.
Your medical billing staff needs to know when each change becomes effective to do their job.
What’s Your Time Worth?
You’ve got to be honest about what your goals are.
If your goal is to expand your OB-GYN practice, then managing your practice's in-house medical billing function probably means you’ll have less time to spend on critical business development activities. So you may want to seriously consider outsourcing.
If you enjoy the administrative aspects of running a practice and feel more comfortable having total control over the entire receivables accounting function, then perhaps keeping this function in-house may be the best fit for you.
If you’re frustrated with the time you spend working in your practice, rather than on it, it might be well worthwhile to consider outsourcing your billing.
Similarly, if you’re frustrated with the amount of time you’re spending on billing-related administration and want a more balanced schedule that allows you to take more personal time, an outsourced solution could be the best investment you ever make in your business.
When Do You Bring In The Professionals, a Medical Billing Service?
Ultimately, this is a question each physician must answer for themselves, based on their resources and business philosophy. But just because you can do it yourself doesn’t necessarily mean you should. For example, many people make the mistake of thinking they’re saving money filing their own tax returns, only to discover just how costly mistakes can be in the end.
At Heartland Medical Billing & Consulting, we don’t recommend outsourcing simply because that’s our field of expertise. We know that outsourcing this function just makes good business sense. Our OB/GYN medical practice clients tell us all the time how much pressure and stress we’ve taken off their shoulders, and that they’re able to spend more time working with patients and meeting their personal and professional goals. We think that’s priceless.
We invite you to visit us here to find out more about how Heartland Medical Billing & Consulting can be your OB/GYN practice’s total billing solution.