Using digital records, billing, and communication in healthcare helps facilitate streamline internal workflow and effective communication. Yet, with layers of regulations designed to protect patient information, the environment is complex. It is vital to adequately evaluate potential medical billing firms to ensure data protection.
There are two levels of medical billing outsource companies. The first provides only medical billing services by submitting and following claims. With the growth of the industry, a second category has emerged – revenue cycle management. These companies provide a large user platform including the administration of financial transactions. However, they ultimately encompass any interaction between the patient and the healthcare provider from the first appointment until the last bill is paid. The range of services can include:
- Central scheduling
- Digital management
- Provider enrollment
- Financial Counseling
- Data Analytics
- Patient liability estimation
- Demographic and insurance verification
The basic goal of medical billing or revenue cycle management is to ensure the provider is paid for their service. Outsourcing medical billing can help healthcare practice manage revenue and reduce overhead costs, such as equipment, software, staff, and employee expenses.
Key Players in 2020
There is a potential danger in choosing the least expensive outsourcing option, as this can realistically cost more in the long run. Some companies don’t have enough security for data protection, compatible technology with current systems, or may not provide efficient service, negatively impacting cash flow. IMARC identified five of the top key players in the medical billing landscape as part of a global industry trend and forecast for 2020-2025.
In the past decade, the industry has experienced strong growth as the interface with healthcare practices improve the complex revenue-generating process and reduce the practice workload. Since no company is immune from fraudulent activity and data breach, it remains incumbent on the healthcare practice to diligently check any company they entrust with patient data and to continue to monitor activity.
1. R1 RCM
The company was founded in 2003 as Accretive Health. In 2017, they were renamed R1 RCM. The company provides revenue cycle management services to healthcare practices, private physician groups, hospitals, and other health systems. In 2018, R1 RCM acquired Intermedix Corporation, another revenue cycle management, and practice management company. In June 2020, R1 RCM announced they expected to close on the acquisition of Cerner RevWorks in the third quarter of 2020.
Allscripts Healthcare Solutions was founded in 1986 as a medical management company located in Chicago, IL. They branched out to information technology in 1997. The company currently provides electronic health records, practice management, and revenue cycle management. The products and services are offered using a strong network distribution.
The company was established in 2004 by the founder of Scour, a multimedia internet search engine. The company is headquartered in Irvine, California. Acquisitions between 2013 and 2015 have provided the company with a strong base to provide a wide technology platform for independent practices. The growth earned the company recognition as one of the fastest-growing companies for four consecutive years in 2016.
4. Experian Information Solutions
Experian was established in the U.S. in 1968 in data management. The company has been providing revenue cycle management for 25 years, offering a frictionless experience between payers and providers and using artificial intelligence and machine learning to automate productivity and match data. Their platform manages financial solutions and counseling.
5. Quest Diagnostics
The company began in 1967 as a pathology lab. After several rebrands, and being acquired by Corning Glass Works, Quest Diagnostics spun off as an independent company in 1996. Their revenue cycle management product, Quanum, provides services to hospitals and private physician groups. They offer electronic medical records, practice management software and medical billing service using their financial solutions platform.
How COVID-19 Has Affected Medical Billing Companies
Small healthcare practices have been disproportionately affected by the COVID-19 pandemic, which in turn has affected medical billing or revenue cycle management companies who serve them. Large companies have not been immune but are weathering the storm with greater resources. As medical practices are cutting costs to survive, they also are evaluating their overhead costs that may be eliminated. One survey found:
- 85% of medical practices taking steps to reduce the financial burden
- Nearly 37% of practices automating workflow
- 33% creating new payment plans for patients
- 28% putting remote payment options in place
It’s important to choose a medical billing or revenue cycle management company that fits the immediate needs of the practice and can grow with the healthcare provider in the future. During these unprecedented times, it’s important to have an eye to the future, while paying close attention to the present circumstances. A strong medical billing or revenue cycle management company can partner with healthcare providers to offer their resources as changes to the healthcare system unfold.
Gail Morris is a freelance writer in health and wellness. She spent over 20 years as a nurse and nurse practitioner before hanging up her stethoscope and picking up the pen. She began her writing career 10 years ago and has since written 2 nonfiction books and is working on her third. Health and wellness is her passion and she loves boiling down complicated research studies into actionable strategies that help improve health.