The healthcare industry in the United States is undergoing rapid transformation. As 2025 develops, healthcare leaders face increasing pressure to manage their revenue cycles with optimal efficiency. In this environment, outsourcing is emerging as a critical solution for healthcare providers aiming to hit their revenue cycle goals.
These insights from 3Gen Consulting will help you explore why medical coding outsourcing companies for audits, risk adjustment, and clinical documentation will be indispensable in 2025 and how it can help revenue cycle leaders navigate the coming complexities of the USA medical billing landscape.
Revenue Cycle Challenges Will Define Medical Coding Outsource Challenges in 2025
Several factors are making revenue cycle management even more challenging for leaders and their teams, increasing the number of providers who want to outsource medical coding services.
Denial Rates Are on the Rise
According to Healthcare Finance News, healthcare organizations are reporting rejection rates as high as 10% to 15% and rising [1]. These denials are delaying payments and draining resources in tracking, follow-up, and collection. According to AHIMA, denial rework costs an average of $25 per claim for practices and $181 for hospitals [2].
Outsourcing medical coding to specialized companies can help reduce denial rates and the cost of rework by ensuring accurate coding and timely submission of claims and increasing efficiencies of claims that do need to be pursued.
Patient Responsibility Is Increasing
High-deductible health plans (HDHPs) are becoming increasingly common, shifting more financial responsibility onto patients. Rising out-of-pocket costs often mean providers are struggling to maintain cash flows, even as operating margins tighten for many.
Outsourcing companies can help streamline medical billing and medical coding to improve accuracy in patient responsibility and ensure that provider cash flows stay as healthy as possible.
Healthcare Regulations Continue to Change the Medical Coding Outsource Landscape
With a shift in presidential administration, many providers expect new rules and requirements to be introduced in the near future. This is on top of maintaining compliance with regulations like the Affordable Care Act, the No Surprises Act, CMS announcements, and updates to ICD-10 coding standards, all of which require expertise and training of staff. This is especially true in the area of medical coding audits and minimizing legal risk.
Medical coding outsourcing companies stay up-to-date with these changes, helping their partners stay compliant and avoid penalties.
Payer Contracts Are Increasingly Complex
Negotiating and managing payer contracts is becoming increasingly challenging, especially with the rise of value-based care options.
Mistakes in medical coding or medical billing can negatively impact cash flow and put additional strain on revenue cycle departments. Medical coding outsourcing companies serve as an external resource to navigate these complexities, relieving leadership of day-to-day management challenges and resource demands.
Medical Coding Outsourcing Companies Are Critical in 2025
Outsourcing medical coding offers numerous benefits that can help healthcare providers not only survive but thrive in the challenging landscape of 2025. Partnering with medical coding outsourcing companies offers some common benefits.
Outsourcing Helps Manage Costs
Hiring and training in-house coding revenue cycle staff can be expensive, especially given the ongoing need for training to keep up with coding changes like ICD-10 and the coming ICD-11. Outsourcing drastically reduces these costs, providing revenue cycle leaders with access to a team of highly skilled coders at a fraction of the price. At the same time, these partnerships help reduce denial rates and improve collections, so outsourcing can significantly boost revenue.
Medical Coding Outsource Partners Help You Scale
One of the biggest challenges for revenue cycle leaders is doing more with fewer resources. Outsourcing coding functions to partners helps leaders scale even as demands for trained and educated billers and coders increase. This flexibility can help ensure that coding is completed accurately and on time, even as claims volumes fluctuate.
Free Your Team to Focus on Core Business Functions
Outsourcing medical coding allows revenue cycle departments to focus their efforts and align with the core mission – the patient experience.
Outsourcing partners free revenue cycle leaders and staff to concentrate their time and resources on the highest-value business functions. This change helps to improve operational efficiency and can also help enhance patient satisfaction when revenue cycle resources are dedicated to this type of initiative.
Increase Competitive Advantage
Providers need every advantage they can get in attracting and retaining patients. Outsourcing revenue cycle allows providers to focus resources in areas that help increase competitive advantage, such as improving the patient financial experience. This includes reducing errors in coding, improving billing practices, and creating a more enjoyable customer service experience.
By examining and acting on your need to outsource medical coding services from a competition perspective, providers can gain a competitive edge, ensuring their revenue cycle is optimally focused in 2025.
Work With 3Gen Consulting Today
As the healthcare industry continues to evolve, medical coding outsourcing companies are emerging as a highly beneficial partner for healthcare providers aiming to achieve revenue cycle success in 2025.
It’s becoming increasingly clear in 2025 that outsourcing will be more than just a strategic option – it will become a necessity for healthcare providers to thrive in an increasingly complex and competitive landscape. To explore the possibilities of medical coding outsourcing for your organization, contact us at 3Gen Consulting today.
References
[1] J. Lagasse, “Claims denials on the rise, complicating revenue collection, survey finds,” Healthcare Finance, 30 September 2024. Available: https://www.healthcarefinancenews.com/news/claims-denials-rise-complicating-revenue-collection-survey-finds.
[2] L. Poland and S. Harihara, “Claims Denials: A Step-by-Step Approach to Resolution,” AHIMA, 25 April 2022. Available: https://journal.ahima.org/page/claims-denials-a-step-by-step-approach-to-resolution.
