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presentation

Upfront Realization as the catalyst for accelerating Physician reimbursement

February 03, 2012



 

“As physicians juggle with their core medical focus and issues related Upfront Collections, there would eventually be an adverse impact on their ability to afford quality medical care. Therefore, sooner or later, they would have to decide on outsourcing the competent services that can offer the best upfront Collection as part of the comprehensive Revenue Cycle Management.”

Seamless reimbursements have remained pivotal to sustenance and growth of medical practices large and small, and will remain so in future also. As the ability to render quality medical services primarily hinges on physicians’ capacity to fund and install the requisite infrastructure, an efficient Revenue Cycle Management becomes indispensable. Amongst many approaches to successful Revenue Cycle Management, Upfront Realization of the eventual cost of medical care has consistently been more effective.

Upfront Collection thrives on the ground that patient understand the importance of supporting physicians’ endeavors for quality medical care; also, being realized during scheduling and admitting, the cost of realization would seem negligible. Although it might seem an easier task than done, alas, the actual execution can be exhausting and tricky – ascertaining and communicating financial obligation upfront is altogether a different proposition involving structured financial clearance prior to service, metrics for performance improvement, and crucial strategies for developing a culture of collection.

One popular way doing this is using a price estimator of the eventual cost of medical care during pre-registration based on the incidental medical benefits. But, because most of the patients would not be able to fulfill their financial obligation fully, physicians may well have to either operate on discounted fee or serving on good faith. Alternatively, CPT code correlated estimation, wherein the actual description of medical services is tallied against the conforming CPT code for arriving at the eventual cost of medical care, may also be followed. And for those patients who cannot afford the immediate payment, long-term payment plans may prove to be suitable option.

In normal course, these reimbursement exercises would not have been so demanding. But, because of the intricacies involved in medical insurance policy arrangements – co-pays, deductibles, the extend of coverage, communication void between the providers and the insurance carriers – the Upfront Realization has tended to be grueling exercise for the physician fraternity.

As preemptive solution for easing the complexity, physicians can have recourse to:

  • Streamlined communication strategy to instill up-front collection as part of a provider’s culture: a patient-friendly means to communicate with patients aimed at promoting a culture of asking for upfront payment of the eventual cost of medical care from the patients.
  • Staff training, including role playing, scripting, and training on using the tools available when discussing financial responsibility with patients. Involving CFOs to help hold their teams accountable, monitoring performance, and frequently discussing importance with associates.
  • Advanced software infrastructure that supports metric-based calculation of such upfront medical fees

As physicians juggle with their core medial focus and issues related Upfront Collections, there would eventually be an adverse impact on their ability to afford quality medical care. Therefore, sooner or later, they would have to decide on outsourcing the competent services that can offer the best Upfront Collection as part of the comprehensive Revenue Cycle Management.

MedicalbillersandCoders.com – possessing the requisite human and technology resources for comprehensive medical billing and Revenue Cycle Management, comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – should offer physicians the comforting zone.

 

Category : Revenue Cycle Management