Outsourced Medical Billing Services

What outsourced medical billing services cover

Fastora's outsourced medical billing services take over the daily billing work of a practice, from insurance checks before the visit to the last patient balance. Every claim is handled by certified medical billing and coding professionals, and the work happens inside the EHR/PM system you already use.

The work runs in three phases. A Virtual Assistant phase covers scheduling, registration, insurance verification and co-pays collected upfront. A Scriber phase records visit documentation in the EHR in real time. The Fastora Medical Billing phase covers claim submission, payment posting, denial management, AR follow-up and patient billing.

Most practices that outsource medical billing and coding together do so because the two jobs depend on each other: a code that the note does not support becomes a denial, and a denial nobody traces back becomes a habit. Around that core you can add eligibility checks, prior authorization, underpayment recovery, billing audits and credentialing. The full menu is on our medical billing services page.

When outsourcing your billing makes sense

Outsourcing medical billing services is not the right answer for every practice. It tends to make sense when billing problems stop being occasional and start shaping cash flow.

Signs you've outgrown in-house billing

• Claims wait days to be submitted because the same staff also run the front desk.
• Denials are resubmitted without anyone tracking why they happened.
• AR older than a few months keeps growing, or timely filing deadlines are missed.
• A biller leaves and nobody else knows the payer portals, passwords or open issues.
• New providers, locations or specialties bring payer rules your team has not worked with.
• The owner or office manager spends evenings reconciling deposits instead of running the practice.

If two or three of these sound familiar, start by measuring the problem. A free medical billing audit reviews your denials, AR and fee schedules so you can decide on facts rather than frustration.

Outsourced billing for physicians also makes sense at points of change: opening a second location, adding a provider type such as a nurse practitioner or therapist, or replacing a practice management system. Those are the moments when in-house teams are stretched thinnest.

In-house or outsourced: comparing the real cost

The comparison is not salary against a percentage. In-house billing carries costs that rarely appear on the same line of the budget, and outsourcing carries a fee that should be weighed against all of them.

Hidden costs of in-house billing

• Salary and benefits for billers and coders, plus payroll taxes and paid time off.
• Billing staff turnover: recruiting, onboarding and the weeks of slower follow-up while a new hire learns your payers.
• Training and certification to keep coders current with annual code set and payer policy changes.
• Software and clearinghouse fees for the PM system, claim submission, eligibility checks and remittances.
• Coverage gaps when a biller is on vacation or out sick and follow-up simply stops.
• Management time spent supervising billing, answering payer letters and checking reports.
• Revenue that never arrives: denials not appealed, underpayments posted as adjustments and claims that pass filing limits.

Our article on in-house and outsourced billing compared walks through a full cost worksheet. Fastora quotes after the free assessment, and our pricing models page explains how percentage, per-claim and hybrid arrangements work.

What you hand off and what you keep

Outsourcing moves the workload, not the ownership. The practice keeps the decisions that shape its finances and patient relationships, and the billing team carries them out consistently.

Your data stays in your own EHR/PM system. Fastora works inside it under user access you grant, so you can see every claim, note and payment at any time, and you can remove that access whenever you choose.

What changes for your staff

For most teams, the front desk changes least. Staff still greet patients, schedule visits and collect co-pays, unless you choose to hand registration and insurance checks to our Virtual Assistant phase as well.

• Billers and coders in your office can move to front-end work, patient financial counseling or practice operations. Some practices keep one person as the internal billing lead.
• Providers keep signing their notes in the EHR. When a code needs clarification, the coder sends a specific question rather than a general request to amend.
• Office managers stop building billing reports by hand and review the monthly report and dashboards instead.
• Patients with billing questions are routed according to the policy you set, and statements follow the payment plan terms you approve.

The main new habit is a short communication loop: one dedicated account contact on our side and one named person on yours, so questions about a claim, a payer letter or a refund have a clear owner.

How we transition your billing without a cash-flow gap

The risk in any move is the gap between the old process stopping and the new one producing payments. A written transition plan closes that gap by deciding, claim by claim, who works what. How long each phase takes depends on your size, payer mix and whether any provider still needs enrollment, so we set dates with you rather than quoting a standard timeline.

A phased transition plan

1. Assess: a free claims audit of denials, AR by payer and fee schedules, so both sides know the starting point.
2. Set up access: individual user accounts in your EHR/PM system and clearinghouse, a signed business associate agreement, and confirmation of ERA and EFT routing.
3. Check enrollment: each provider's effective dates and IDs confirmed with each payer, with credentialing started where anything is missing.
4. Go live on new claims: from an agreed date of service, new charges are coded, scrubbed and submitted by your Fastora team.
5. Work existing AR: older claims are sorted by payer, age and filing deadline and worked in priority order, starting with balances closest to timely filing limits.
6. Review: the first monthly report and review call confirm what is working and what still needs attention.

If you are leaving another billing company, the plan also names who works the run-out of claims already submitted, how open denials are handed over and how the outgoing vendor returns your reports. Our guide on how to switch billing companies lists the questions to settle before notice is given.

Security and HIPAA: BAA, access controls and data location

Handing billing to an outside company means sharing protected health information, so the partner's security practices matter as much as its billing skills. Under HIPAA, a billing company that handles PHI for a practice is a business associate, and a business associate agreement must be signed before any patient data is shared. Fastora signs a BAA before accessing PHI.

Fastora's workflows are aligned with HIPAA and HITECH, with encryption, secure server environments, strict access controls and regular internal audits. Access to your EHR/PM system is set up with individual user accounts, so every action can be traced to a person.

Onshore vs offshore teams

When you compare an onshore medical billing company with vendors that use offshore teams, ask where every person who can see PHI works, which subcontractors are involved and whether your payer contracts or government programs place limits on where member data may be accessed. Fastora is a US based medical billing company headquartered in Austin, Texas.

Put service levels in writing

A service level agreement (SLA) turns promises into checkable terms. Useful items include how often claims are submitted, how quickly enquiries are answered, which reports arrive each month, who approves write-offs and how your data and reports are returned if the agreement ends.

Outsourced RCM services for small and growing practices

Small practices feel billing gaps fastest, because one or two people usually hold all of the payer knowledge. Outsourced RCM services spread that knowledge across a team and add reporting a small office rarely has time to build. Our page on medical billing for small practices covers solo providers and small groups in more detail.

Specialties we support

Billing rules change by specialty, so the team assigned to your practice works with your code sets and payers every day. We support behavioral and mental health practices, including psychiatry, psychology, therapists and counselors, as well as physical, occupational and speech therapy, rehabilitation and sports medicine.

We also bill for a broad range of physician specialties, from internal medicine and pediatrics to orthopedics, cardiology, radiology and pain management, plus ambulatory surgery centers and home health and hospice. See the full list on our specialties page.

Reporting you can check

Outsourcing only works if you can see what is happening. You get transparent dashboards, monthly performance reporting and a monthly review call covering collections, denials by reason and payer, and AR by aging bucket.

Custom reports are available on request, and your dedicated account contact can answer questions between reviews. Our reporting and analytics service lists the measures we track and how each one points to a specific fix.

How to choose a medical billing outsourcing company

When comparing partners for medical billing outsourcing services, look past the headline rate to how the work is done. Ask who will handle your account, whether coders are certified, how denials are tracked to root cause, what reports you will receive and how often, and how you get your data back if you leave.

Healthcare RCM outsourcing also differs by specialty. A partner that bills mostly for one type of practice may not know the authorization rules, time-based codes or payer policies that matter most to yours, so ask for examples of how they handle your highest-volume services.

• Is the scope written down, including what happens to existing AR?
• Who signs the BAA, and are any subcontractors involved?
• How are payer letters, refunds and credit balances handled and approved?
• What does the monthly report show, and is there a review call?
• What are the notice terms, and how are open claims handed back at exit?

RCM outsourcing works best when both sides agree these points before go-live. The same questions apply whether you are outsourcing for the first time or replacing an existing vendor.