With reimbursement squeezed from all angles, providers are increasingly looking to maintain profit margins by cutting costs and increasing efficiencies, often by outsourcing billing and other business activities.

According to the February HME NewsPoll, 18% of respondents outsource more services now than they did two years ago.

Hiring an outside firm to tackle the complex world of DME billing was the most popular task to outsource, with 71% saying it freed them to focus on business and ensures they squeeze every possible dollar out of reimbursement.

"Managing the day-to-day operations keeps me busy," said Paula Vineyard, owner of Respiratory Therapy Services in Dunbar, W.Va. "Keeping up with Medicare changes and reimbursements is time consuming, and I have always preferred to let the experts handle it."

But Mike Kuller, president of Allstar Oxygen Service in Concord, Calif., prefers to keep a tight rein on billing.

"I would be very reluctant to outsource an important function like accounts receivable, since cash collection is the lifeblood of my business," he said.

Providers must examine their core competencies to determine where to focus time and energy, said David Bargmann, COO of Homecare Collection Services.

"Providers are getting squeezed by accreditation and reduced reimbursement," he said. "Most providers are understaffed to begin with. Outsourcing is a key to financial well-being as long as they find the right partner."

One up-and-coming area for outsourcing is supply replenishment--such as CPAP filters and tubing--said Bargmann, and 29% of poll respondents agree.

Malinda Mason, quality assurance manager for Kingsport, Tenn.-based Resp-I-Care, is gearing up to outsource CPAP/BiPAP replenishment.

"It's too time consuming for internal staff to perform the calls," she said.

Other areas ripe for outsourcing include deliveries, tracking patient compliance and human resource management, say industry consultants, but billing and collections remain the most commonplace.

Delegating the delicate task of patient collections has an obvious benefit, says one provider.

"With an outsourced company making collections calls, we have a better chance of keeping the patients as our customers," said Janie Narducci, owner of Duncan, Okla.-based Advanced Medical Supply.