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Effects on Physicians reimbursements: Insurance Denials and uncertainty of health reforms

May 04, 2012

Insurance denials are one of the major factors that affect a physician’s revenue even though health reforms do address some issues faced by patients and physicians in dealing with insurance companies, the denial rate of claims has not significantly altered due to such reforms. These insurance denials are avoidable especially as they create problems for physicians and providers and delay or even eliminate the possibility of proper provider reimbursement. Dealing with insurance companies is tough enough for experienced physicians; it is even tougher for new physicians who have limited hands-on experience in such matters.

The reforms have played a significant role in reining in insurance companies and some of these policies may work but still remain to be fully tested. The survey conducted by The United States Department of Health and Human Services finds that the rate of denial is 19% but the denial rate increases with the age group of the patient. People who are older face more denials compared to young individuals and this is a worrying trend for a population which is continuously aging. The Government Accountability Office (GAO) has released a report on insurance denials which sheds some light on the nature of insurance denials- it states that in many cases the denied claim, if appealed, is often reversed. This survey also clarifies that the number of denials due to the inappropriateness of the service provided by the physician are less than those because of billing errors and eligibility issues.

The health reforms are going to  affect the insurance scenario in the sense that as now even people with pre-existing conditions can get insurance- this essentially means that physicians are more likely to see increased number of sick patients which in turn would increase the average physician-patient encounter time. The other aspects that will affect the insurance scenario in the country are that since there would be a large influx of consumers in the form of the previously uninsured 32 million Americans which would benefit the insurance companies to grow. However, initially insurance providers would see a drop in their revenue due to decreased profits and increasing number of claims.

Physicians and providers stand to gain from the health reforms in the long run and the way in which these new policies will affect payers even though some payers may decrease the physician reimbursement amount. Nevertheless, insurance denials are always going to be one of the major problems that providers will have to face in the future even after the implementation of reform policies.

The best way to deal with insurance denials is to ensure that denial management and payer interaction are performed by experienced professionals for better results. Such denial management and payer interaction can be performed in a professional and efficient manner by the largest consortium of medical billers and coders in the United States, medicalbillersandcoders.com Billers and coders in the consortium can not only assist in better denial management and payer interaction but also offer numerous other value added services such as revenue cycle management, research, and consultancy.

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Category : Revenue Cycle Management