Many urgent care facility owners believe managing billing services in-house will give them the most control over their revenue. Our urgent care medical billing services experts put this theory to the test and this is what they found:

Myth #1: In-house billing specialists cost less than an outsourced revenue cycle management (RCM) partner.

Comparing in-house billing specialists to an outsourced RCM partner is like comparing apples to oranges–it’s just not the same thing. For the sake of this myth, here are a couple of things we explored.

You might be able to hire a relatively inexpensive billing specialist, but what is their level of expertise? Are they experts in ALL areas of revenue cycle management? An outsourced partner costs a percentage of your billing, but their team has expertise in every aspect of RCM. This includes coding, compliance, claims submission and negotiation, collections, and more. To have this collective expertise in-house, you’d need to hire an entire team of people that would be significantly more expensive than the cost of an outsourced team.

Result: Myth BUSTED!

Myth #2: You have more control of your revenue cycle with an in-house medical billing specialist than an outsourced RCM partner. 

Many urgent care owners believe they will have the most control over their cash flow by hiring an in-house specialist. What our experts have found, however, is that hiring an in-house billing specialist is like putting all of your eggs in one basket. Not only are you solely relying on their expertise, but also on their availability. If this person needs time off, or finds another job, how would you keep billing up-to-date? With an outsourced partner, you have no downtime because you have a team dedicated to your revenue cycle management. Therefore, an outsourced team’s availability and expertise give you more control over your revenue cycle than an in-house specialist.

Result: Myth BUSTED!

Myth #3: An in-house billing specialist can manage the entire revenue cycle of an urgent care.

Hiring an in-house billing specialist means hiring someone to focus on billing after a patient visit. However, this is just a small part of the revenue cycle.

Billing starts at your front desk.Having financial processes set up at patient check-in is critical to accurate and timely billing. An outsourced partner can provide processes for patient check-in that include:

  • Capturing demographic information (name, DOB, address, phone number)
  • Insurance information (carrier, policy number, group number)

Once patient information is captured, the next step of the process is ensuring that all aspects of the patient’s visit are correctly captured in their chart including past medical history, presenting symptoms, length of symptoms, prior treatment, etc. This critical information allows urgent care medical billing specialists to code claims correctly when submitting them to insurance carriers for reimbursement.

Claims management is the next step in the cycle. Inevitably, a carrier will deny a claim for one reason or another. It’s then up to the billing specialist to respond to that denial and resubmit the claim with an accurate code, or more information. With in-house specialists, those denials often go untouched because they take time to manage and can cause backlogs. An outsourced team has the resources and incentive to dedicate time to each denial resulting in optimal reimbursement for the urgent care facility and physicians.

Patient billing and collections are also a critical part of the revenue cycle. Again, an outsourced team is able to manage billing and collections from patients because they have more bandwidth than a single, in-house specialist.

Result: Myth BUSTED!

Myth #4: An in-house billing specialist reduces my liability.

This is an easy myth to test. As stated before, revenue cycle management requires many pieces working together to maximize reimbursement. On top of this, regulatory compliance is complex, especially in states like Texas, and regulations are always changing. Remaining compliant requires a billing specialist to stay on top of all regulatory changes and updates and to quickly adjust to them as needed. Compliantly managing an urgent care’s full revenue cycle is a tall order for a small in-house billing department.

Hiring an outsourced urgent care medical billing group means you decrease your liability as it is their responsibility to maintain compliance at all times.

Result: Myth BUSTED!

While urgent care billing seems less complicated than other medical specialties, the best way to control your revenue cycle and cash flow is with an outsourced billing specialist like Gryphon Healthcare.

Gryphon Healthcare was founded and is operated by healthcare professionals that learned how to maximize reimbursement through skilled revenue cycle management for our own practices and departments. Now, we’re using our experience and expertise to help other healthcare organizations do the same.

If you’d like to learn more about our urgent care medical billing services, schedule a call with our revenue cycle team. In the meantime, download our whitepaper about how outsourcing revenue cycle management to a partner like Gryphon Healthcare can help you save time, energy, and money.