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presentation

How Much Does It Cost Your Practice To Interact With Payers?

June 26, 2013



Though a large portion of physicians’ administrative costs include expenses incurred while interacting with health insurance plans, there seems to be very little data about the level of these interactions.

Nevertheless due to the high costs incurred physicians have for a long time shown discontent with the time their administrative staff ends up spending on these activities.

Industry Standards State

  • A survey result showed physician practices while dealing with patient health plans incur an average cost of nearly  $68,274 per physician each year
  • While interacting with health plans - physicians reported spending 3 hrs per week; whereas nursing and clerical staff spent much more than 3 hrs per week on these activities
  • National time cost to practices of interactions with plans was calculated to be between $23 bn. - $31 bn. per year (time converted to dollars)

Additionally administrative costs incurred by US physician practices are nearly $83,000 per physician each year, approximately 4 times the sum spent by their Canadian counterparts. Hence US physicians use nearly 12% of their net patient income in covering administrative costs and can save nearly $27.6 bn. in annual health care spending by matching Canada’s administrative costs.

Practices can drastically improve their bottom-line by reducing some of this time and money spent!

Facts about patient interaction in US

  • Time spent on an average on patient interaction by physicians 3 weeks; nursing staff 23 weeks and clerical staff 43 weeks, roughly per physician per year.
  • Only a small part of this time is spent on quality of data – 2 hrs per year by the average physician, and little more by the staff.
  • Primary care providers’ mainly small practices spend more time on health plans interaction compared to other specialists.
  • The estimated cost due to health plans to physician practices equals 6.9% of all U.S. expenditures for physician and clinical services.

Interaction with health plans across varied types of interaction, staff, specialty and practice size involve few specifics- Prior authorization, Pharmaceutical formularies, Claims, Credentialing, Contracting and Data Quality. Majority of physicians’ spend maximum time on dealing with formularies, and then on authorizations.  Other health plan interaction related costs include- equipment, supplies, telephone, fax, office space, or time spent by NPs and PAs.

How can physicians benefit from health plan interaction?

Administrative costs can never be nil, also these interactions may produce benefits -

  • Prior authorization and formulary requirements may reduce costs and improve the quality of care by promoting appropriate procedures and medications
  • Interacting with multiple health plans, though expensive with varied requirements can help provide physicians with increased patient choice

Addressing the Problem – Due to a multi-payer system practices needs to deal with multiple insurance products and different rules and administrative standards compared to a single-payer system, hence facing high administrative costs. Adoption of new payment models like bundled payments; innovative methods of organizing health care delivery along with ACO’s have been introduced to help reduce administrative costs in the long term. However physicians need to also proactively also work towards reducing these costs.

Reducing plan-interaction costs without reducing benefits with MBC

MBC strives to balance costs with possible benefits; by working towards improved interactions between practices and health plans hence reducing costs for both. Our billing experts -

  • With in-depth industry knowledge assist our clients in standardizing transactions and processes with automation to help reduce costs and administrative burden
  • Help physicians understand the complexity of varied patient insurance plans including different benefits, payment rates and billing procedures, through regular industry updates
  • Ensure proper documentation, regular reporting and payment follow-up and collections to help reduce the chance of billing error and disputes
  • Assist in improved interaction to restore trust between payers and physicians in order to achieve real-time prior authorization at the point of care

Increased trust between physicians and payer helps provide a huge opportunity for improving efficiency in a multi-payer health care system. As most of the costs are due to inefficient processes, MBC services help practices save money in terms of –

Reduced reliance on in house staff + Improved interactions with payers

Increased collections improving cash flow

MBC the largest consortium of billers and coders has been providing medical billing services across US for over a decade now; meeting necessary requirements for medical necessity and claims stipulations. Our team is constantly working to identify opportunities which help improve accuracy, compliance and productivity in a multi-payer health care system.

 

Category : Revenue Cycle Management