The administrative costs associated with medical billing within a physician practice are becoming unmanageable for independent and major health-system affiliated practices alike. A 2018 research study was conducted by experts at Duke University and Harvard designed to examine the administrative costs specific to large academic medical centers using electronic health record (EHR) technology – and their findings were staggering.
The study, which was published in the February 2018 issue of the Journal of the American Medical Association (JAMA), featured interviews with 27 administrators of large health systems and 34 physicians. They charted the path of an insurance claim from start to finish – evaluating the entire revenue cycle and assigned a cost to each major activity along the way. This information was carefully evaluated and aggregated to estimate the total cost for processing individual insurance claims.
In an industry where time is money – literally – particularly as we straddle the lines between fee-for-service and value-based care, every minute counts. That’s why study’s assessment was eye-opening for large health systems looking to quantify how much it’s actually costing them to manage medical coding and billing inside their own walls. Here’s what they found.
Estimated Time & Cost for Processing Billing and Insurance Activities
• Primary care visit – 13 minutes or $20.49
• Discharged emergency room visit – 32 minutes or $61.54
• General inpatient stay – 73 minutes or $124.26
• Ambulatory surgical procedure – 75 minutes or $170.40
• Inpatient surgical procedure – 100 minutes or $215.10
…And we wonder why health care costs in this country continue to rise, when it costs $215 just to submit a bill for a procedure?
Similarly, a study published in 2014 by BMC Health Services Research indicated that billing and insurance-related costs in the U.S. health care system totaled approximately $471 billion in 2012. The study also notes that these costs more than doubled between 1980 and 2010.
That’s why expert reports are forecasting a continued rise in the global medical billing outsourcing market over the next five years. One report estimates the global medical billing outsourcing market to hit a compound annual growth rate of 10.5% between now and 2023 – with most of this growth occurring in North America as a measure to help control rising healthcare costs.
Organizations that focus exclusively on coding, billing and enhancing the revenue cycle from start to finish can help lower these staggering costs – while also allowing health care organizations to focus on what they are truly best at – which is providing exceptional patient care.