Medical Billing & Coding Services for Hospitals

At The Outsourcing Medical Billing, we specialize in handling end-to-end medical billing and coding services workflows for hospitals that are facing persistent claim denials, underpayments, AR backlog, and compliance risks. We operate as an offshore extension of your revenue cycle management (RCM) department, ensuring continuity, accuracy, and audit-readiness.

Our work helps healthcare providers, revenue integrity teams, HIM departments, and CFOs reassign internal bandwidth away from operational chaos toward revenue cycle analysis, payer contracting, and compliance oversight.

We Know the Gaps Hospitals Struggle With

Let’s be honest. Most hospitals are stuck in recurring reimbursement issues like:

High claim rejection rates due to incorrect or inconsistent ICD-10 and CPT code mapping.
Delayed reimbursements from incomplete clinical documentation or late chart abstraction.
Inefficient RCM workflows caused by staffing shortages or high churn in billing teams.
Inconsistent AR follow-ups, particularly on aging claims > 90 days.
Payer-specific rule misalignment that leads to time-consuming rework and denials.

These are not surface-level issues. These are systemic breakdowns that lead to cash flow gaps, revenue leakage, and auditing risks.

We step in where your internal team leaves off, providing the technical, domain-specific support to plug those gaps with measurable ROI.

Our Services

We offer a tightly integrated suite of billing services and coding services, with specialization in hospital systems, multi-specialty groups, and inpatient care networks. All work is performed within strict HIPAA compliance protocols, with audit trails, TAT (Turnaround Time) SLAs, and dual-layer QC. Our solutions ensure accuracy, streamline processes, and support healthcare providers in managing revenue cycle workflows effectively.

Medical Coding (ICD-10-CM, CPT, HCPCS)

Certified coders with domain expertise across cardiology, oncology, orthopedics, general surgery, and critical care.
Real-time code abstraction from physician notes, operative reports, and discharge summaries.
Compliance with NCCI Edits, LCDs/NCDs, and payer-specific guidelines.

Charge Entry & Validation

Charge capture from EHR with code-level validation against encounter documentation.
Edits to catch charge omissions, under-coding, and compliance discrepancies.
Integration with your EHR and PM systems for automated batch submissions.

Claim Scrubbing & Submission

Rule-based scrubber to validate modifiers, place-of-service, diagnosis-code linkage.
Submission via clearinghouses with daily batch logs.
Built-in feedback loop for immediate correction of front-end rejections.

Denial Management

RCA (Root Cause Analysis) for denials across CARC codes.
Intelligent appeals workflow with payer-specific rebuttals.
Data tagging to track recurring denial reasons and reduce rework rates.

AR Follow-up & Collections

Aging buckets split into 30-60, 60-90, and >90 days.
Prioritization matrix based on payer, claim amount, and denial status.
Daily activity logs with next-action triggers.

How Our Service Fixes the Real Problem

We don’t just submit claims. We close gaps in hospital revenue cycles with actual system-level interventions.

High Volume, Low Yield in Surgical Coding

Hospital surgical team produces 60+ operative notes daily. In-house coders are 10 days behind. Coding errors cause a 22% denial rate.

Our Fix: We assigned a 3-coder pod with surgery specialization. Achieved 24-hour TAT with 98.7% coding accuracy (audited monthly). Denials dropped by 16.4% within 60 days.

Legacy AR > 120 Days Piling Up

Multi-location hospital system has $1.3M in aging claims >120 days, with no clear ownership internally.

Our Fix: Deployed AR recovery team, segmented claims by payer and service line. Within 90 days, recovered $746,000 across Medicare, UHC, and BCBS.

High Staff Attrition in Billing Team

Internal billing team turnover leads to inconsistent charge entry, frequent missed charges.

Our Fix: Set up dedicated remote billing unit. Introduced pre-submission QC. Within 30 days, charge lag dropped from 6 days to under 24 hours.

Compliance, Audit & Reporting

HIPAA-compliant infrastructure with endpoint encryption and role-based access.
Dual-authentication for PHI access.
Audit logs and QC reports available weekly.
ICD-10 compliance with ongoing CEU-trained coders.
SOC 2 Type II certified processing centers.

Reporting & KPIs Tracked

We don’t just process—we measure, constantly.

Claim First-Pass Resolution Rate (FPRR)
Charge Lag & Coding TAT
Denial Rate by Payer
AR Days by Bucket
Appeals Success Rate
Clean Claim Rate

Frequently Asked Questions

Do you support HL7 integration for hospital EHRs?

Yes. We can integrate with most HL7-compliant systems including Epic, Cerner, and Meditech. We also support SFTP and API-based data exchange.

Can your coding team work with physician queries for documentation improvement?

Yes. We offer physician query support and CDI-focused reviews to improve DRG accuracy and prevent downcoding.

What coding guidelines do you follow for hospital inpatient claims?

We use ICD-10-CM and PCS, with MS-DRG grouping logic and compliance with official AHA Coding Clinic guidelines.

Do you handle Medicare Advantage plans and their unique denial codes?

Absolutely. We segment claims by payer plan and use specific workflows for Advantage plans, including appeal letter generation based on plan rules.

How do you manage coding audits and accuracy metrics?

Every coder’s work is subjected to dual-level QC. We conduct random monthly audits and report error rates per coder and specialty.

Can you assist with prior authorization workflows?

While not our core service, we offer optional support for prior auths, particularly for radiology and surgical procedures.

Let’s Talk Numbers

Hospitals we work with have reported significant improvements in their operations through our Medical Outsourcing Billing services, including a 21-28% reduction in denial rates and a 2-3x faster AR resolution on aging claims. Additionally, they’ve experienced a 3-4 day improvement in coding turnaround times (TAT) and up to a 97% clean claim rate within 60 days. To ensure continued success, we measure performance on a weekly basis, deliver detailed reports with exception tracking, and adjust team allocation in response to your claim volume trends.