Generating revenue is a basic need for businesses to run smoothly. This stands especially true of running successful healthcare facilities. However, the noble cause of treating patients is put to financial risk by the constantly changing healthcare reforms.
The main source of earning revenue for medical practices in the US is the reimbursement from payers. Medicare and Medicaid plans of the Affordable Care Act (ACA) make up the maximum percentage of insurance coverage followed by private insurances.
Importance of Medical Billing
The main source of earning revenue for medical practices in the US is the reimbursement from payers. Medicare and Medicaid plans of the Affordable Care Act (ACA) make up the maximum percentage of insurance coverage followed by private insurances. This process involves in-house staff members who have to look after everything from appointment scheduling, transcribing, filling the CMS-1500 claims form, submitting them to respective insurers, working on denials to following up with the payers until the payment is made. It is a long and time taking procedure.
- Erroneous Submissions Lower Revenue
The statistics reveal that the most common reason for delayed payments is erroneous form submission. It constitutes a major 30% of the reason why physicians have to wait for long duration to receive their due.
- Follow up is Part of Billing Process
Many a times the physicians have to completely forego their payment because of lack of following up with the payers. The staff is so burdened with administrative and other tasks like coding and compliance that spending at least 15 minutes for every phone call to the payer is next to impossible. Besides that, if the accounts receivable (AR) falls into the next level of the 30 / 60 / 90 bucket the chances of collection lowers significantly.
- Payment Posting and Reports
An important part of the medical billing process is posting the status of payments, checking whether the practice has been reimbursed as expected and for properly for every respective patient. However, the main aim of this process should be to generate reports after analyzing the trend of reimbursement by per insurance payer. This proves to be helpful in strategizing and planning the submissions for different medical billing specialties.
Thus, if your medical billing cycle is interconnected in a smooth way and functions without glitches, you can be sure of collecting maximum revenue for your practice. Nevertheless, it is also noted that practices of different sizes fail to streamline their billing cycle due to the many systematic steps involved along with compliance issues due to which many practices are losing more revenue than before. In such situation the only feasible option to save costs and comply with the healthcare changes is outsourcing the billing process to a vendor.
Billing partners have dedicated teams for conducting the different steps (including AR calling team) and they take only 24 – 72 hours (depending on the specialty and client) for coding and filing the claims. Specialist and experienced coders are assigned specific medical specialties to do the coding according to latest standards (ICD-10). So, if your practice’s financial health is wavering, outsourcing can help you revive your practice and enhance the productivity too.