Want to promote revenue integrity and stop the endless cycle of claim denials? Hire experienced medical billers.
It’s a mantra we’ve all heard before: You get what you pay for. The idea is that saving more on the front end sometimes ends up costing you in the long run. When it comes to revenue cycle management (RCM), this couldn’t be truer. While it may be tempting to hire less expensive novice medical billers, doing so may negatively affect your revenue integrity (i.e., your ability to get paid accurately and completely for the services you provide). When you hire a medical biller with less experience, you save money on their salary, but you may lose money on the back end through claim denials, underpayments, and write-offs.
It’s a conundrum because there’s an ongoing shortage of medical billers and coders, especially in rural areas. To complicate matters, larger health systems in urban areas often attract seasoned professionals with lucrative compensation packages that their rural counterparts simply cannot offer. For example, did you know that medical biller income increases by 43% on average from entry-level to late career, according to the American Academy of Professional Coders’ 2024 Medical Coding and Billing Salary Report?
All of this leaves rural hospitals and critical access hospitals with seemingly few options. Some healthcare leaders may feel that any medical biller in their centralized billing office is better than none. As a result, they compromise on their minimum job requirements simply to fill vacancies and address discharge-not-final-billed accounts.
Savvy healthcare leaders, on the other hand, recognize the link between medical biller experience and revenue integrity. They understand that without quality RCM in medical billing, the organization’s financial future may be in jeopardy. That’s why they set and maintain clear expectations for medical biller experience—and they do what it takes to ensure standards are met.
Here are four ways to embrace this same mentality and promote revenue integrity in your own organization:
1. Don’t settle. If recruitment efforts aren’t successful, don’t continue to spin your wheels or wait for a candidate who may never appear. Instead, consider partnering with an outsource RCM vendor that can provide highly qualified medical billers with the precise experience your organization needs. If you do end up hiring a medical biller who is less experienced, be sure to pair them with a mentor for ongoing audits until they reach satisfactory productivity and accuracy levels. And once they’ve gained experience, do what you can do to retain them.
2. Invest in ongoing education. What types of claims does your organization tend to submit repeatedly to payers without success? These are the cases in which medical billers need education and training. Go beyond the basics. Remember: An investment in medical biller education is an investment in your organization’s bottom line.
3. Hire an experienced billing manager. Successful managers have the right combination of subject matter expertise, people management, and project management as well as the ability to foster communication between medical billers, medical coders, and clinical staff. Again, if recruitment efforts don’t yield the candidate you need, consider partnering with an outsource RCM vendor to find the right fit. Remember: This is the person who sets the tone for RCM in medical billing. They establish the key performance indicators, develop policies and procedures, and make hiring decisions. Hiring the wrong person can have a negative domino effect on revenue integrity.
4. Create a succession plan for RCM leaders. Succession planning, which includes a system for internal talent development, is a key workforce strategy. Your most tenured RCM staff could be nearing retirement, and you’ll need a plan to memorialize their institutional knowledge and experience so it can be passed on to others. Important steps in this process include identifying potential candidates to fill critical roles, building criteria for readiness to move into these roles, and evaluating progress along the way. If your succession plan reveals potential future gaps, an outsource RCM vendor can help. Incorporating this vendor into staffing conversations as early as possible helps mitigate operational catastrophes.
Looking ahead
As healthcare organizations strive for revenue integrity, experienced medical billers are paramount. With the right experience, medical billers increase clean claim rates, decrease days in accounts receivable, reduce denials, and improve overall cash flow. Learn how Inland RCM can help.