Maximizing Reimbursement under Medicare Physician Payment

Nothing is more aggravating than not receiving credit for work done. Physicians frequently leave substantial sums of money on the table because insurance providers need to recognize the work for numerous reasons even though services were performed. This is notably noticeable in preventive medicine and wellness visits with adult and elderly patients, leading to the undervaluation of physician services. Here various aspects of Medicare physician payment and offers tips and strategies to help healthcare providers optimize their reimbursement.

In fact, several improvements and trends implemented in the reimbursement process have impacted the healthcare industry. Medicare and Medicaid have reduced physician reimbursement. The HIPAA terms and standards have tightened the criteria for claim data submission. To ensure appropriate invoicing, the government has heavily emphasized healthcare abuse and fraud.

According to research, one in every three Americans with health insurance needs help paying their medical expenditures.

But the question arises:

How to Maximize Reimbursement under Medicare Physician Payment?

To maximize the reimbursement under Medicare physician payment, you must implement effective strategies such as:

  • Obtain Correct Information

Check that all demographic information is correct and that you have entered it correctly. This will hasten the reimbursement process. It will assist you in eliminating resubmission and denial rates if you have all the correct typos before filing the claim.

One of the finest practices is to confirm your patient’s contact information with each visit. Also, when you use an outsourcing medical billing company to check the address and collect updated data, you increase your chances of being paid in a single effort.

To determine a patient’s eligibility, make sure to identify the following:

  • Insurance of patient
  • Co-payment commitment
  • Associated coinsurance
  • Remaining deductibles

  • Implement a Financial Triage Strategy

An efficient financial strategy that begins with patient access will assist your clinic in obtaining maximum patient and payer payment. The number of claims denied has increased due to eradicating demographic and typographic flaws. You can gain visibility by gathering more precise and detailed information.  Increased visibility will aid in gauging the patient’s likelihood to pay, allowing you to decide which patients to refer to charity and which people to enroll in payment plans with the option of auto-draft.

  • Patient Payment Propensity

To gain insight into the patient payment predictor, you must first understand their income levels, if they have credit available to pay, and any outstanding medical debts.

Once you’ve determined your patient’s ability to pay, your staff can take the next step in exceptional circumstances where the patient falls below the federal poverty level and is eligible for Medicaid. Registrars should notify a group within the clinic that will assist them in enrolling in government plans.

In some circumstances, if patients are unwilling to pay out of pocket, your staff can recommend them to charity treatment. Writing off these accounts immediately will eliminate the A/R and associated costs. Means of payment and visibility in credit history will assist your clinic in understanding the approach to support patients.

  • Collect Before Care

Always equip frontline employees with the capacity to collect patient payments at the moment of service. Offer your patients multiple payment arrangements and the option of auto-draft with high deductibility. Remember that interest-free payment plans are preferable to not being paid. This will help you improve your collection rate, increase your A/R velocity, reduce administrative costs, and eliminate the need for collection agencies.  It will be easier to collect reimbursement if people know what they will be charged for ahead of time.

Outsource to Enhance Reimbursement Rate!

Every physician wants to improve their bottom line, but getting paid for what they do is equally important. You must outsource the tiresome and painstaking coding and billing process to a competent company like 24/7 Medical Billing Services for your personnel to perform effectively. Outsourcing the medical billing process will benefit your clinic in the long term by developing more robust and stable revenue cycle management systems for you. In addition, outsourcing will reduce your operating expenses while increasing revenue cycle efficiency.

With our pro billers and coders, 24/7 Medical Billing Services assisted many healthcare providers across the United States in optimizing their medical billing process. With over 10 billion transactions annually, our billing experts are well-versed in 60+ medical specialties. Other services we provide include claim submission, denial management, insurance verification, and other healthcare management services.

See also: Optimizing Your Revenue Cycle: Strategies For Proactive Medical Billing


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