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.