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Why Most Physicians Get Paid Within 60-90 Instead of 14-30 Days?

September 26, 2012

Amidst rising costs of operations and declining reimbursement rates; increasing Accounts Receivable (AR) days is a major concern with physicians as partly paid, late or denied payments can significantly impact a practice’s bottom line.

Minimum payment days: On filing a clean claim the minimum time a physician will be paid differs on the payer: Federal payers - (Medicare/ Medicaid) – pay clean claims within 13-15 days and other commercial payers - pay clean claims within 27 to 30 days
Industry standards: Claims generally take anywhere between 40 - 169 days to be paid, with an AR cycle of generally 60 90 days

Why delay?

Get It Right the First Time! -Claims are typically delayed or denied due to human error or misfiling. Additionally a variety of factors can influence why claims are not paid immediately, including:

  • Claim may not be for a covered contract benefit
  • Patient's preexisting condition is not covered or patient coverage has been cancelled
  • Case is under consideration as Workers' compensation (WC) is involved
  • Payer considers the physician's procedure experimental
  • Preauthorization for a procedure or for hospitalization was not obtained
  • Services were provided prior patient's health insurance contract went into effect
  • Payers may ask for additional information
  • Payer has requested information about another carrier for coordination of benefits

How to get paid faster?

Self-assessment is a vital step your practice can take to better understanding the processes used and also discover opportunities for improving the processes to help improve payments and AR. Following questions can assist Physician’s in determining cause and also do a maintenance assessment:

  1. How many claims were submitted in the recent 30 day period?
  2. Of those claims approximately what percent were denied and most frequent reasons for the denial?
  3. Of those claims approximately what percent were delayed and most frequent reasons for the delay?
  4. Does the denied or delayed percent vary between paper and electronic claims?
  5. Does the billing staff track the percent of claims that are denied on the first submission?
  6. Is there a policy in place for bad debt collection?

Getting paid faster with the help of a billing service?

Billing errors and late payments can cost a practice a loss of nearly 10% and at times even 30%, hence many physicians short of time to implement all the above by themselves are opting for a billing service.

Outsourcing all or portions of the billing operation to specialists is a growing trend in the US healthcare industry especially due to high costs, shortage of trained staff and new era of value based care.

  • The top 20 outsourcing firms, based on the number of national healthcare clients, reported 13.1% growth from 2010 to 2011
  • US Healthcare provider outsourcing is projected to have the highest growth rate of 31.9% from 2011 to 2016 driven by ICD-10 transition implementation

Reducing your AR days with MBC…

Being specialist in billing services our Medicalbillersandcoders.com experts are constantly looking for avenues to bring down your AR days, some of the procedures we have in place include- weekly & monthly reporting, review of EOB's, reason for denials, getting required documentation, regular follow-up process, dedicated appeals team and studying of contracts before it reaches appeal stage.

Medicalbillersandcoders.com the largest consortium of medical billers and coders serving healthcare for over a decade across all US States and varied specialties by applying all the above standards has a past track record of:

Reduced Denials: nearly 10-15% + AR days reduced: 30-40% + Savings: nearly 32%
Cleaner claims: 97% + 1st pass denial rates: less than 3% + Enhanced collections: 10-15%

Resulting in thousands of dollars of added revenue!


Category : Accounts Receivables / Claims Denials