I recently heard from a medical biller who almost closed her doors in 2020. Even in the best of times, owning a medical billing business has its challenges. Given that biller revenue is directly tied to services provided to patients, the economic impact of the coronavirus due to fewer doctor visits has caused some billers to question their future. To be sure recovery seems to be imminent but the k-shaped recovery coming out of the COVID-19 pandemic has affected medical practices and their billers in different ways, creating disparate realities among different communities.
So, is medical billing even a good business in 2021?
In short, yes. Here is why:
It is good to be in a growing market. Healthcare is growing at a faster rate than any other industry, with revenue increasing over 6% by the end of 2020 and continuing to grow (Source: CSI Market). A trend that prevailed pre-pandemic and has started picking up again is that more patients (due to an aging population) are going to the doctor, and U.S. medical costs continue to rise.
It is good to be wanted. Coming out of the pandemic, doctors are looking hard at staff costs and many are recognizing that patient billing is not their core competency, thus generating a greater need for outsourcing their patient billing.
Billers are needed to help address complex challenges.
Due to constantly changing billing codes, rules from payors, insurances, non-communicative EHRs, and additional codes (ICD), doctors and physicians are not necessarily equipped with the up-to-date information to stay on top of the complexities of billing. They have their own set of concerns to prioritize. In addition, patient bills and statements are still not transparent or easily understandable by patients, so the medical biller is the first line of defense to explain these bills and their respective reason codes.
Patient statements themselves are still overly complex especially regarding what is required to be outlined on the bill. For example, a single visit or surgery can include many different fees such as facility fees, inpatient versus outpatient information, multiple doctors for one visit (some in- or out-of-network versus “specialist”), deductible versus coinsurance, and the list goes on. From a New York Times article on patient bills: “That system, with its lines of alphanumeric codes and arcane medical abbreviations, has given birth to a gigantic new industry of consultants, armies of back-room experts whom medical providers and insurance companies deploy against each other in an endless war over which medical procedures were undertaken and how much to pay for them. Caught in the crossfire are Americans, left with huge bills and indecipherable explanations in languages they cannot possibly understand.”
It is good to be providing a better alternative. While insurance billing has become more and more automated, patient billing is still a pretty outdated process, relying heavily on manual tasks, paper, and phone calls. There is opportunity for growth and development in the industry, and medical billers are the ones who can substantially improve this process as more capabilities become available to them.
Medical Billing also presents a great opportunity for your innovative ideas; insurance billing is well understood (and is becoming commoditized), but patient billing presents an opportunity to differentiate. Today's digital consumers and providers looking to spend more time with their patients look forward to your contribution.
Finally, I am glad to report that the medical biller who almost closed her doors in 2020 did stay open, has kept her team of six employed, and is now seeing new practice growth. Well done, and how about you?