Medical Billing Services: A Safe Passage for Denial and Delay Management

Payer denials and delays is a cause of worry for every doctor in the US. A denied or a delayed claim leads to loss of revenue for the physician. To top it all the physicians are now looking at an uncertain future working in the Medicare program due to introduction of reimbursement cuts. In the light of recent events, it is crucial that doctors be paid on time for the service they render to patients. Medical billing services have created a safe platform for medical institutes and doctors that manage end to end billing cycles and leaves medical practitioners to concentrate on their core responsibilities, i.e. to provide healthcare. 

Let’s review the current economic situation facing physicians before we begin to focus on how medical billing services can offer the much needed respite to the medical fraternity. 

The Current Economic Climate 

There is an atmosphere of ambiguity looming over the US healthcare industry. The Congress has initiated a 27.4 percent cut in doctors’ fees under the Medicare program. These cuts have been proposed to control and balance the healthcare budget. Though the physicians have received some reprieve until this legislation takes effect; the cuts have put an undue strain on the doctors practicing in private clinics. 

This economic crunch is forcing doctors to run their private practices by tapping into their personal assets. Generally a third of patients that a doctor treats are on Medicare. With private insurers also following Medicare rates the reimbursement amounts are further plummeting. Cuts proposed in this program will leave doctors in a difficult position. They will not be able to keep up with costs of running a private facility. This may lead to closure of private clinics thereby creating a shortage of medical resources available to public. 

Until the government finds a more permanent solution to fix this problem doctors and physicians have to focus on being reimbursed appropriately and timely by payers to ensure their practices stay afloat. 

Why Medical Billing Services? 

An assured way to guarantee accurate and timely payment of claims is to outsource the billing process to medical billing companies. It has been noted that medical billing companies can save up to 40% in costs for physicians and hospitals. To understand the benefits of medical billing services, it is important to first discuss why claims are denied or delayed by the payer. 

Issues surrounding delays and denials: 

• Incorrect patient or insurance details
• Lack of supporting documentation
• Incomplete claims
• Inaccurate Coding
• Doctor’s clinic submits claims to wrong insurer
• Lack of communication with the payer
• Not having an AR process in place to follow up on delayed claims 

Amidst all the mayhem besieging denial management, doctors’ income suffers a massive blow. Due to denials, hospitals’ lost proceeds accounts for 6% to 10% of net revenue nationwide. This figure specially looks bad because 90% of denials are actually preventable. Medical billing companies can manage billing requirements efficiently. It can fortify the financial condition of a clinic or hospital. Let’s evaluate the ways in which billing services adds value to the medical industry.

Advantages: 

• Dedicated team that specializes in denial management
• Coding specialists code the claims
• Client specific billing models put in place
• Work is done as per HIPAA compliance
• Fast and accurate methods deployed to submit claims
• AR team follow up claims in a timely fashion
• Use of pronounced billing software 

Cost reduction is a major challenge facing medical practitioners today. By seeking services from medical billing companies  issues ensuing from delayed and denied claims can be nipped in the bud. Medicalbillersandcoders.com is the largest consortium of billers and coders across the U.S that specializes in denial management. Their skills also extend to other areas of billing such as credentialing, managing accounts receivables, charge entry and payment posting.  MBC has perfected the art of medical billing because they understand the value of time and money.

Improve your Revenue by Overcoming Hurdles in EMR implementation

There has been a definite improvement in the United States in the adoption of Electronic Medical Records (EMR) and its implementation in the last decade (2001-2011). A report by Centers for Disease Control and Prevention (CDC) states that 57 percent of office-based physicians in the country have adopted EMRs. However, 34 percent of physicians only have a basic system, which means that only 22 percent of physicians have a fully functional EMR system. Therefore, only 22 percent of physicians are qualified for the incentives and are demonstrating “Meaningful Use” (MU). The reasons for the poor adoption rate of fully functional EMR systems lie in the numerous functional hurdles faced by providers in successfully implementing a fully functional system.

The steep learning curve involved in fully implementing EMR/EHR systems is one of the biggest hurdles that are faced not just by physicians but also by their staff.

• The complicated process of complying with the “Core” and “Menu” objectives in the demonstration of MU is just the tip of the iceberg
• The technical support, training, maintenance, and cost of implementation are the hidden prerequisites that make the process of full EMR/EHR implementation a cumbersome and delicate process

Office-based physicians have found it more difficult to fully implement a functional and complete EMR even though they would benefit more from the incentives compared to hospitals.  The revenue of office-based physicians is definitely going to be affected after 2015 when health reform policies are fully implemented. The adoption of a universal health policy that insures almost 32 million uninsured citizens has added a new dimension to the hurdles faced by physicians in the adoption and implementation of fully functional EMR systems. Physicians are short of time are striving to streamline all the processes from scheduling to revenue cycle management in order to create a steady platform for demonstrating MU through efficient EMR/EHR implementation.

The health reforms have not just affected the core functions of physicians but have also impacted the way in which various other departmental processes are carried out. The migration from ICD-9 codes to ICD-10 codes, new insurance policies, expansion of the scope of medical coding procedures, adoption of innovative IT services, and the changing payment models implicate a paradigm shift in the way health care is delivered and the way in which providers operate.

In this scenario need for an active approach through a medical billing service towards payer interaction and denial management is being felt as the wheels of health reform start to turn, medicalbillersandcoders.com, catering to US physicians across all states for more than a decade now, offer not only medical billing and coding services but also provide better revenue cycle management, professional denial management services, effective payer interaction, fully functional EMR/EHR implementation consultation and other ‘back office’ services essential for boosting revenue and providing qualitative services to patients.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

AR aging over to 120 days – Is it Prudent to opt for a medical billing service?

Accounts receivables (A/R) management is a vital element of revenues for physicians and forms a crucial part of a physician’s revenue because of the role of insurance companies and other similar entities in the whole revenue cycle process. There are several methods of managing accounts receivables and there are no common techniques of evaluating this aspect of a business.

One of the most sought after methods of calculating the A/R balances is utilizing a A/R aging schedule -by separating the ‘age’ of Accounts Receivables into “buckets “ from 0-30 days, 31-60 days old, 61-90 days old or 90 days and older. The most unwanted scenario would be where the A/R is 120 days old and this definitely means that a mistake has been committed either by the payer or the insurance company or during medical billing and coding. The chances of an error occurring or even deliberately made by an insurance company is one of the major factors that can cause such a delay in A/R and denied claims due to errors by insurance companies stands at almost 19% of all claims submitted.

The reluctance of insurance companies to pay is a factor that seems universal- however the key aspect is the efficiency of the medical billing and coding and how the back-office staff performs. A/R aging over 120 days is not uncommon and numerous hospitals, physicians and providers have at least 10% of their claims which have aged over 120 days. However, the dampener is that A/R over 120 days are usually not paid and the majority of these need to be written off.

The best method of ensuring 95-98% payment is to prevent the A/R or claims denied or pending to go over 90 days and this can only be done by following certain measures:

• Interaction with payers plays a crucial role in ensuring that delays are avoided and resubmission of claims is speedy enough to avoid the aging of A/R over 90 days
• The role of Health IT is also crucial in A/R since it reduces the time and days in A/R and also helps in reduction of errors since claim submission is increasingly becoming electronic
• Moreover, the reforms have also played an important role in that it has provided the opportunity for medical billers and coders to expand their coding base which allows for little room for errors and is also HIPAA compliant

However all these factors may come together to pave the way for increased volume of medical billing that is expected in the near future due to government policies, heightening the need of a stand-alone entity that follows aggressive collection policies and does not commit any errors in claim submissions. Hence some physicians find prudence in opting for medical billing service which either charges a flat fee for their services including A/R, while some charge the physician or the provider only when remuneration is procured.

Medical billers and coders at Medicalbillersandcoders.com serving the healthcare industry for over a decade has been managing the entire Revenue Cycle of various physicians across diverse specialties and all 50 States. MBC’s billers and coders easily integrate all factors like- HIPAA compliance, up-to-date knowledge of the billing industry along with the support of extensive research that helps in providing services that are attuned to a healthy A/R which in turn saves the physician lost revenue due to lesser denials and delays in claim submission.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Appealing a claim- Will a standard format work to improve your practice’s medical billing?

The procedure of appealing an insurance claim is intricate, although it can be successful if completed properly because there are many grounds for claims to be denied by an insurance company or a payer. The payer collects a lot of claims on a daily basis and the claim can be easily denied if there has been a mistake in analysis or Medical Billing and coding errors including many others. Furthermore, there is also a requirement to understand if the claim is of importance because a claim of a very small amount need not be appealed and can be written off but one which is worth a considerable sum needs to be scrutinized. However the physician’s office in this case may need to apply various measures considered the following challenges.

In Denial

The fact that a physician or practice receives the accurate amount of reimbursement even when the claim is not denied is a wrong assumption. Insurance companies may con a physician out of his or her fair share of reimbursements in many ways that are very difficult to detect and need a dedicated and keen professional to find the lacunae in the proper reimbursement of physicians since almost 19% of claims denied are due to errors of the insurance companies. This especially holds true in the case of private insurers due to errors made by the insurance companies in claims and detecting these errors requires skill and sustained effort. As a result some physicians and practices are reluctant to appeal denied or underpaid claims since this may increase the administrative work and expenses. However, nothing can be further from the truth when considering the long term repercussions of the monetary benefits that can be enjoyed even with 5-10% increase in revenue which can be a considerable amount.

The Impact of Reforms

In the face of reforms, revenues are set to increase dramatically along with administrative and billing process as 31 million uninsured Americans receive insurance. Appealing a denied claim is becoming voluminous but the new billing and coding procedures are aimed at making this process of reimbursement or appealing much smoother with the transition from ICD-9 codes to ICD-10 codes and adoption of the 5010 platform and emphasis on quality care and patient privacy through HIPAA compliance. The importance of time and money cannot be overemphasized and denied claims, especially for private insurance companies, have to be appealed within a stipulated period of time after the claim is denied. Therefore preventive steps to save time such as error reduction through analysis and a scientific approach in Revenue Cycle Management (RCM)  is required in order to sustain the low rate of denial over longer periods of time.

Vital Signs

Analyzing the pattern in which claims are denied by an insurance companies and finding out the most common false denials is a crucial part of the process of appealing denied claims. Denied claims can fall in various categories such as:

•    Errors in documentation
•    Services not covered
•    Mistakes in medical billing and coding
•    Technical difficulties involving Electronic Health Records (EHRs)
•    Not considered “medically necessary” by the payer

Arguing your case becomes more difficult due to the huge amount of laws, rules, and regulations that seem to drown the actual cause of the denial. Thus customization of claims becomes much easier when they can be categorized and scientifically solved within a given period of time.

Scientific approach

In this scenario appealing a claim may require more than a standard format and physicians short of time can benefit by acquiring services of a Medical Billing Service. Medical billing and coding experts at Medicalbillersandcoders.com not just perform basic coding and billing functions but are also backed by a team of research professionals who ensure efficient RCM, productive payer interaction, and a scientific approach towards collections with the “bucket” approach in Accounts Receivables (AR) and prompt reimbursements for physicians and practices all over the country with complete HIPAA compliance.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

‘Pay-as-you-go’ as a value-based medical billing service model

While we are not alien to the term ‘pay-as-you-go’, it is something that is catching the imagination of physicians opting for outsourced medical billing services. Unlike in the past, when ‘pay-as-you-go’ was sporadically availed by a few physicians, it is now emerging as a viable alternative to long-term contractual medical billing services. Well… what is this ‘pay-as-you-go’ service model after all and what makes it so affable to physicians opting for outsourced medical billing services? Much true to its name, ‘pay-as-you-go’ service model’ is a niche medical billing service wherein physicians are obliged to pay their service provider (usually a percentage of the eventual reimbursement) only when they approach for getting their bills reimbursed. Usually, a percentage is worked out prior to soliciting ‘pay-as-you-go’ medical billing services from prospective medical billing companies. The reason why the present-day generation physicians deem ‘pay-as-you-go’ service model’ appropriate is primarily because of their restrictive financial ability as well as being able to transact on value-based system. 

The surge in the demand for ‘pay-as-you-go’ service model’ has its roots in a combination of factors – spiraling cost of contractual billing services, continuous fall in reimbursement rates, rapid increase in stand-alone or small physician practices, and less incidence of insurance-backed medical services, popularly known as cash-based services. The thought of countering this adverse impact on physicians’ revenues through in-house medical billing seems to have lost its significance amidst the monumental cost associated with switch over to mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational mandate. While physicians are convinced of the efficacy of ‘pay-as-you-go’ service model’ in countering their sagging revenue fortunes, service providers need to be equally responsive to such demand from physicians. Notwithstanding it being an additional service portfolio in the medical billing companies’ service offering, many medical billing companies are apprehensive of the future of the contractual model. But, their reasoning may not be true. 

The main reason why they may not be true in assuming ‘pay-as-you-go’ service model to be detrimental to the future of the contractual model is the fact that large hospitals, clinics, multispecialty groups, and more importantly the ACOs will continue to drive the demand for contractual model of medical billing services.  Therefore, ‘pay-as-you-go’ service model will not come in the way of their main service portfolio, but will only evolve to be an additional revenue source. In view of such scope for additional portfolio of service, medical billing services would do well to strategically expand their ‘pay-as-you-go’ service model to the areas where challenges faced in medical billing are rampant. On the whole, it puts both physicians as well as service provides in a win-win position. 

While most of the medical billing companies are still analyzing the pros and cons of ‘pay-as-you-go’ service model, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – has already begun to reach to the physician practices in need of ‘pay-as-you-go’ service model. The strategic spread of its diverse medical billers and coders across the regions dominated by stand-alone practitioners makes it easily accessible and affordable.