The Smart Medical Practice

Is that Sound Ice Cracking or Opportunity Knocking for Medical Billing Services?


M edical Billing OpportunityOne of the hardest tasks for small business owners is taking a step back to evaluate their business by looking at where the industry is, where it’s going, and where the opportunities are. So let’s take a moment to do just that.

We’ll start with the fact that the outsourced billing sector is growing at 12% to 14% annually. The main reasons for that growth?

  1. Complex regulations
  2. Lack of resources within practices
  3. Technology that doesn’t function well and/or isn’t properly integrated
  4. Difficulty finding and retaining talented billers
  5. Highly inefficient. Lost claims (more than 15%) and claims with mistakes (more than 30%), and denials due to eligibility, authorizations, or improper coding cause medical practices to generate more than $700 billion in administrative waste every year.

At the same time, the medical billing sector is experiencing some significant issues. Specifically, it is:

Highly fragmented. There are a huge number of small, undercapitalized companies and a handful of larger players.

Extremely disjunctive. 75% of billing services are using standalone medical billing software that cannot interact seemlessly with the medical office. Most billing companies still manually re-enter superbill data from their practices into these outdated legacy systems. A surprising number of billing services still use an old version of software that is not 5010 compliant.

Ripe for shakeout. There are approximately 8,400 medical billing companies vying for physician’s outsourced billing, but only a small percentage are able to compete technologically with the Athena’s of the industry. As AthenaHealth now reports possession of almost 25% of the medical billing market (and growing at 27% annually), the recent entrance of massive RCM competitors like ADP, McKesson, AllScripts, eClinicalWorks, CareCloud, and Kareo, bode ill tidings for small undercapitalized billing services that lack end-to-end Practice Management technology.

Put all these circumstances together, and you quickly see a landscape of tremendous change, terrifying risk, and potentially huge opportunity. Billing companies able to offer relief to practices struggling to comply with HIPAA, prepare for ICD-10, and implement or improve electronic medical records to achieveMeaningful Use are holding a golden ticket. The key is their ability to convince potential clients of their worth. They must be prepared to effectively demonstrate what advanced technology and efficient personnel can mean for the practice’s bottom line.

Overview of PracticeSuite Medical Billing Software


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