A lot of healthcare startups come to us asking whether or not they should start their own billing company because their clients don't seem to know how to do it or drag their feet on it, or ask for education on how to do it most appropriately.
Indeed, there are some benefits to doing so, as it can lead to control and customization, efficient costs, data ownership, and integration with other systems. In terms of control and customization, a billing company created by a startup will result in the billing process to meet the unique needs of the startup. In addition, the startup can easily adapt to their billing processes to changes within pricing, models, products, or services. A perk of starting a billing company is that it would give the startup full control over customer data, which would enhance security and secure compliance with industry specific regulations. Finally, there could be streamlined operations, such as an internal billing system that can be tightly integrated with other business systems, such as customer relationship management.
Despite the benefits to starting a billing company, there are many challenges. For example, the upfront cost of developing a billing system can be prohibitive for a startup with limited capital. Additionally, starting a billing system requires significant technical expertise, which can divert focus and resources from the startup’s business operations. Next, there could be significant growing pains as the startup expands; in other words, the billing system must constantly evolve to handle increased volume and complexity, which is quite difficult to manage internally. Creating a billing company also involves dealing with sensitive information, which is quite complex; thus, there’s regulatory issues one must be mindful of. From a legal perspective, licensed physicians are the only ones that are allowed to diagnose and prescribe to patients and without a licensed physicians' sign off, billing isn't possible. Lastly, there can be a focus diversion or an opportunity cost to start a billing company. These costs can lead to diversion from invested in marketing costs, time commitment, expanding manpower, or purchasing additional equipment.
One possible workaround this is for startups to outsource their medical billing services. Having an outsourced team to handle medical billing means partnering with an entire billing department with the resources, expertise and compliance guardrails to do this appropriately. There’s also a lower risk of errors, as a dedicated team of experts can give the necessary time and attention needed to unpaid claims and billing. In addition, the more efficient operations in the claim submission process results in faster payments and lower accounts receivables which can be critical for cash flow management of the startup. Furthermore, there’s decreased liability with outsourcing medical billing services; with the increased transparency of data such as denial rates, an outsourced team will provide full awareness of a comprehensive revenue cycle and how to improve it.
Navigating market access and pricing in the digital health sector requires a strategic approach and deep understanding of the healthcare system. By focusing on evidence generation, payer engagement, and value demonstration, you can enhance your product's market potential and drive successful commercialization.
At Akros Advisory Services, we specialize in accelerating market entry and driving successful commercialization for digital health tech founders. Our comprehensive go-to-market playbook and advisory services are designed to maximize your chances of success. For more information and to take the next steps in your market access journey, visit our website.
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