Billing and compliance are two of the common ways healthcare practices get in trouble. Much as they are independent concepts, they are best approached as one. Complexity, uncertainty, and limited time or resources can make billing compliance difficult to achieve. As a consequence, a practice may suffer unnecessary scrutiny, hefty fines, reimbursement denials, or worse, loss of licensure.

Read on to discover what healthcare billing and compliance entail so you never fumble when it matters.

What is Compliance in Healthcare Billing?

Let’s start with the individual definitions first.

Healthcare billing is the process of generating and submitting insurance claims for reimbursement of services rendered. It involves gathering patient information, confirming insurance coverage and benefits for the patients, and coding procedures and diagnoses.

Healthcare compliance is the practice of adhering to federal laws, regulations, guidelines, and ethical standards governing the healthcare industry. These laws are intended to eradicate cases of fraud, abuse, and waste.

Going by the above definitions, compliance in healthcare billing is the process of adhering to the laws, guidelines, and regulations related to billing practices. It involves ensuring that healthcare practices follow the laid-down rules and ethical standards when submitting claims for compensation. 

The field of healthcare billing and compliance is too complex, and too fast-changing, to take any chances. Healthcare billing compliance professionals must be well-acquainted with the latest and greatest laws and regulations at all times. They must also be able to think on their feet and not crack under pressure.

Why is this Important?

Compliance in healthcare billing is vital to the success of any practice. Staying in the good graces of entities like OIG and regulations like HIPPA when billing protects the practice from any and all legal and financial consequences. This helps keep practices operational, financially healthy, and allows them to maintain a strong reputation.

There are many reasons why billing compliance is crucial to your practices. Here are a few outstanding ones:

• Adherence to healthcare billing guidelines ensures practices steer clear of legal repercussions. Fines, penalties, and loss of licensure are all possible outcomes of non-compliance. 
• Billing compliance helps to strengthen a practice’s financial standing. When the law is followed to a tee, practices maximize revenue through proper and swift reimbursement.
• Compliance to billing regulations helps to avoid unnecessary audits. Non-compliant practices are at a high risk of getting audited by insurance companies and regulatory bodies, which can be time-consuming, costly, and disruptive.  
• Compliance in billing contributes to the reputation and trustworthiness of practices. No patient or insurer wants to work with a practice that is in bad standing with the law.

Why Outsourcing is the Way to Go

Many healthcare practices choose to outsource their billing and compliance to a third-party company. This is a smart move because of the following reasons:

• Dedicated expertise: Even the most adept practitioners struggle to keep up with the intricacies of billing and compliance. Add to that ever-changing laws and increased scrutiny, and the process becomes murkier. Third-party providers have designated teams with expertise in handling complex billing regulations, coding guidelines, and reimbursement process. It’s their bread and butter.   
• Cost savings: Managing billing and compliance in-house can be costly. Outsourcing removes the ongoing costs associated with acquiring new technology, training staff, and keeping up with changing regulations. Instead, practices pay a fee to the provider, which translates to considerable cost savings through economies of scale.
• Focus on core competencies: Healthcare practices exist for one reason and one reason only: to provide essential care to patients. However, they are distracted from this core focus when they handle billing and compliance in-house. Outsourcing the mundane and cumbersome tasks involved leaves room for practices to do what they do best.

Many reputable providers offer healthcare billing and compliance services, so it’s important to do your due diligence before making the final decision.

If you would like additional help on this topic, please don’t hesitate to contact us today at myeMED. Medical billing is our second name, and we draw great pleasure in helping practices like yours get to the next level of compliance, profitability, and long-term stability.