Implementation of the Patient Protection and Affordable Care Act (PPACA) has led to an increase in the medically insured population. Although this act has ensured better quality of life and facilitated people in receiving quality care, as well as helped implement a better payment model, it has subsequently burdened the medical providers (hospitals, clinics, and physicians). Reimbursement reductions and shift in patient volumes has led to medical service providers, especially hospitals, facing a 25% decline in their revenue. The challenge lies in persisting bad debts and uncollectible accounts. The medical billing process is more complex and demands to stay up-to-date with the changing guidelines and upgraded and rewritten codes for diagnosis & treatment. As a result of these challenges, many hospitals are choosing to outsource their medical billing to address the medical billing issues.
Reimbursement delays, increasing legislative & regulatory pressure, changing technology & lack of expertise, making certain the collection of full copays, bad or missing documentation, problems with medical coding, lack of capture of accurate patient information, and approving of procedures not mentioned in preauthorization forms are some significant challenges faced by several healthcare providers. Performing these tasks requires experienced billing specialists who are up-to-date in latest medical coding. Hiring in-house billing staff would include high labor and technical staff costs. In addition, the organization has to pay for training costs to make sure the staff is up-to-date with changing guidelines for state reimbursement, payer rules, and coding.
Perceiving the requirements of the industry, current outsourcing companies are offering revenue cycle management services to ease the process. These services are focused toward helping the companies control operating costs and overcome the challenges faced. Gradually, medical billing outsourcing is expected to be a major market in the healthcare industry as more and more providers will look toward outsourcing their medical billing process to coding and billing specialists. Medical billing outsourcing is expected to drive revenue growth and as hospitals gain better insights about their revenue management and cash flow, the companies providing the outsourcing services are expected to see growth in their clientele volume.
Some leading vendors in the market are Allscripts Healthcare Solutions; Cerner Corporation; GE Healthcare; McKesson Corporation; SSI Group; Accretive Health; Experian Information Solutions, Inc.; and Quest Diagnostics. Medical billing outsourcing is essential to any business's strategy and these companies provide their services by integrating technical expertise and
IT resources to provide services that adhere to current industry needs. Some other prominent vendors in the market are Athenahealth, Emdeon, Epic Systems, CareCloud Corporation and CureMD.
In-depth report on global medical billing outsourcing market by Grand View Research: