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    Revenue cycle management: Is it time to outsource?

    Outsourcing to a vendor

    Pro: It can maximize revenue

    Practices that lack internal expertise with coding, billing, contracting or working denials can generally increase revenue by outsourcing to a reputable firm, says Jacqueline Coult, CHBC, owner of Salt Lake City-based Complete Healthcare Business Consulting. 

    Con: The costs can add up

    Vendors typically base their fees on a combination of factors, including claims volume, specialty and the specific services they’re providing, so it’s important to understand what’s included, says Michelle Durner, CHBME, president of the Healthcare Business Management Association, which represents 500 revenue cycle management providers. For example, does the vendor employ certified coders? Is provider enrollment, contracting, credentialing and/or preauthorization included in the cost, or broken out separately?

    Pro: Greater efficiencies

    Staff can shift their focus from performing routine billing tasks to more pressing issues that require their attention.

    Con: Loss of control

    Amy Shoales, FACMPE, practice administrator of Physicians for Women & Children in Laramie, Wyoming, prefers the immediacy and control of maintaining an in-house team. Onsite access to providers enables her team to resolve coding and billing issues faster than an outsourced vendor, she says.


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