The Role of A Medical Billing Company in Complex US Healthcare System

American health spending is high — almost 18% of the economy, and over $10,000 per person per year is spent on healthcare.

The U.S. health care system is a unique hybrid system -unlike many European countries, the USA doesn’t have a uniform healthcare system. Around  50 percent of U.S. health care spending comes from private funds, among which 28 percent coming from households and 20 percent coming from private businesses. The federal government accounts for nearly one-third of the expenditure, while state and local governments accounted for 17 percent.

As the insurers bear most of the medical bills, there’s a stringent process attached right from documentation to settlement of the claims. Here comes the role of an efficient Medical Billing Service company.

The medical billing process involves a payer, which can be an insurance company or the patient and the healthcare provider. Medical billing addresses the issue of claim settlements. The entire procedure is known as the billing cycle, aka Revenue Cycle Management. Revenue Cycle Management involves managing claims, payment, and billing.

Data shows that the average ratio of staff handling revenue cycle management to doctors is as high as 4.23 FTEs ( Full Time Employees). Above the staff cost, which affects the operational expense directly, there lies a high chance of error in handling paperwork and data. It’s said that 86% of the mistakes made by the healthcare industry are administrative.

So what’s the role of a Medical Billing Partner?

1) First and foremost, the healthcare billing company should be equipped to reduce the burden of operational expenses.
2) They need to be experienced with the handling of multi-practice management and billing systems.
3) With a high focus on data sensitivity, the healthcare billing company should be 100% HIPAA compliant.
4) The medical billing company should maintain transparency in the entire operation process. They should provide a timely report to the outsourcer.

In order to improve the overall condition of the complex healthcare system, the role of an efficient Medical Billing company can’t be undermined.