Why Texas Providers Are Turning to Outsourced Coding: An Introduction
Texas is a large state with vast rural areas and competitive metro regions. With this, its healthcare landscape extensively spans it all. In today’s ever-changing healthcare system, most providers are now turning to outsourced medical coding services to escape the need to solve some of the most frustrating operational coding and billing challenges on their own.
The challenges can come from anywhere:
- Complex Insurer Landscape: Due to the uniqueness of the fragmented Texas payer industry, commercial insurance plans, Medicare, and Texas Medicaid, it can be quite confusing for someone dealing with coding and billing while staying compliant, as each of them has its own coding and documentation requirements.
- Coders Shortage (Inpatient): Many sources, such as Reddit user discussions, suggest that there is a shortage of expert inpatient coders, especially in Texas.
- Increase in the In-House Staffing Cost: To have an in-house team of coders demands a high cost for salaries, software, and benefits. A lot of mid-sized and small practices are not able to afford and maintain in-house staffing due to inflation driving up the healthcare labor costs.
- Administrative operation inefficiency: due to administrative burden, there is a substantial increase in the inconsistent documentation audits, risk of delayed claims, and rework due to errors. This eventually results in delayed reimbursements and inconsistent cash flow.
Major Benefits of Outsourced Medical Coding Services in Texas
Cost-effective with quality maintenance
Outsourcing coding services to medical billing firms saves you a lot of time and energy while eliminating the risk of sacrificing your operational efficiency. All of this comes with a low price as compared to the cost of setting up your own in-house team.
Improvement in Claim Success
When you let the experts handle your work, it guarantees quality. Medical billing and coding vendors in Texas have teams of trained experts of coders who are certified to do this job. This frees you from the hassle of getting your staff trained, and instead, you hire those who are already well-versed with the tasks you need the services for. With experience and expertise come fewer denials, and that results in speedy payments and less costly errors.
Accessibility to certified experts
Reputable medical billing and coding firms in Texas offer experts who are AHIMA or AAPC certified coders. These certifications include training for coding languages such as
- ICD-10, CPT codes, and HCPCS Level 2
- Texas-specific payer edits and LCDs
- Specialty coding for e.g., nephrology, mental health, and cardiology
- Risk Adjustment coding (HCC)
Characteristics of an Excellent Outsourced Coding Company in Texas
When outsourcing your coding to any coding vendor, you should keenly look for the following characteristics:
| Characteristic | Indications | |
| Certifications | Prefer specialty certifications because they have a better understanding | |
| Compliance Expertise | Well-versed in the HIPAA, CMS, TMHP, and Texas policies | |
| Strictness with Regulations | Security for sensitive patient information | |
| Technology Integration | Provides Fast processing and fewer errors | |
| Manager availability | All-time availability for round-the-clock communication | |
| Testimonials and Track Record | A good reputation suggests a better outcome in the future |
Evaluating an Outsourced Provider—MIU’s Guideline in Terms of Texas-Specific Vendors
While evaluating a medical coding vendor in Texas, you should look beyond the cost alone. It’s crucial to analyze the depth of the firm’s operational and administrative transparency with honest communication capabilities. A top-notch medical billing and coding vendor must provide detailed reports, denial analytics, and documentation. This not only provides a real-time visibility into the revenue cycle but also builds trust between both parties and streamlines operational activities.
Transparency in compliance coding audits is another aspect that is very essential due to the strict payer policies of Texas. The vendor should be familiar with Texas Medicaid and its related managed care organizations (MCOs) policies and updates. Coding teams should have knowledge of local modifier requirements and documentation nuances so there are fewer chances of human errors occurring.
Lastly, communication is the key. Always choose those vendors who are available at all times as per your needs. Local vendors are better because they align with your time zone and provide responsible communication. In short, expertise, experience, transparency, and good communication are the four pillars of an outsourced coding provider that will boost the financial health of your practice.
The Final Verdict by MIU
Outsourcing is no joke. You should always make a wise decision as a practice owner on who to trust with your medical billing and coding. It can break the backbone of your clinic’s finances. Those who have chosen MIU for their medical billing and coding have benefited in many ways, such as:
- Consistency in cash flow
- Speedy claims acceptance
- No denials and delays in payment
- Expert-level Compliance and Strictness
- Data security
- 100% Accurate and Precise Coding
For states like Texas and its ever-evolving healthcare industry and payer policies, MIU has always stayed up-to-date and is the partner of choice when it comes to thriving and not barely surviving. Contact us now!
