The biggest challenge many healthcare staff face is streamlining their billing process.  Moreover, the entire healthcare industry has been under tremendous stress over the last year due to the increasing number of billing errors. But there is one issue. If the staff gets ample time, then they can improve patient quality. But most of their time goes on correcting billing errors. Moreover, their in-house billing team comes up with high costs. So, what is the solution to this problem?  

The solution is to hire a billing company that will take care of all your billing-related tasks to streamline your claim process. The doctors in the US lose almost $125 billion each year due to poor billing practices. It happens because the providers do not have proper knowledge of the updated billing regulations. That is the main reason many healthcare providers are planning to hire an outsourced billing company.  

Before understanding the challenges, the billing companies solve, let's dive into the CMS update for billing to understand the billing guidelines. But before that, you need to know about PFS.  

PFS (Physician Fee Schedule)  

Medicare started using PFS in 1992 to determine how to pay for your physician services. Always remember that Medicare uses a single payment rate when they pay for the services given in the physician’s office. Medicare also adjusts the payment rates based on the geographic location of the patients. So, it is high time to know about the Medicare 2025 billing guidelines to make your billing service perfect.  

2025 Medicare Billing Guidelines  

PFS rate setting and conversion factor: PFS has dropped by 2.93% from the previous year. It means the conversion factor, which helps set the payment rates, has dropped from $33.29 in 2024 to $32.25 in 2025.  

Billing guidelines for caregiver training service: Medicare has finalized plans to create new codes and payments for caregiver training focused on direct care service and support. Moreover, Medicare is also introducing new codes and payments to improve patient care.  

Billing guidelines for Office/Outpatient (O/O) Evaluation and Management (E/M) visits: Medicare has finalized a proposal to allow payments for the O/O E/M visit complexity add-on code.  

Now, when there is so much noise on billing, let’s understand how billing companies can increase your healthcare efficiency.  

Challenges Solved by the Physician Billing Company  

Complying with the updated regulations: As the billing regulations are constantly changing, it becomes difficult for the providers to get updated with the upcoming regulations. Moreover, the billing regulations are highly complex to manage. That is why it can be a better option to outsource billing companies who have knowledge about all the updated regulations to streamline your billing process.  

Helping with prior authorization: Prior authorization is a very complex problem to manage which kills a lot of time. On the other hand, the billing services come up with specialized experts who have experience in solving all the complex prior authorization procedures. Hence, it not only reduces the claim denials but also increases the healthcare revenue.  

Utilizing advanced technology: Manual billing is a time-consuming process. Though it takes a lot of time, it can have numerous billing errors if not done correctly. On the contrary, billing companies use advanced technologies such as Computer-Assisted Coding (CAC) to reduce billing errors in a very short amount of time, which increases healthcare revenue.  

Final Thoughts  

In short, the billing guidelines are continuously changing, and it is becoming difficult for the providers to comply with the updated guidelines. Moreover, as manual billing process occupies most of their time, it leaves them no time to focus on improving patient care. Apart from that, they efficiently secure prior authorization that leads to seamless claim processing.   

That is why it can be a feasible option to outsource physician billing company that can take care of all your billing-related tasks. As per market research, outsourced billing services save around 80% of the operational cost for providers. Moreover, their dedicated resources only focus on correcting all the billing errors in a short amount of time, so that you can invest your time to improve patient care to increase healthcare efficiency.