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presentation

Alleviating the Time Factor in Evaluating Revenue Generation from Medical Claims

October 17, 2011



“While physicians would not mind investing in revenue optimizing systems, asking them to invest their invaluable time in something which is non-core to their medical efficiency could ultimately have an adverse impact on their efficiency for medical care. Therefore, there seems to be a considerable propensity to outsource Medical Billing Management”

The rapid healthcare reforms promulgated by the Federal Health Department have meant both unprecedented opportunities and threats for physicians across the United States. While the prospect of spiraling patient-base looms large, there also appears an element of apprehension over the effectiveness and efficiency with which they will be able to realize their medical claims amidst a reimbursement environment characterized by stringent audit-verifications. In fact, majority of physicians have expressed concern over unimpressive reimbursement rates despite investing heavily in compliant EHR, electronic billing and coding, and claim submission systems.

The bitter experiences have driven physicians to take stock of the situation, and evaluate their revenue generation from claim reimbursement against resource allocation. While physicians would not mind investing in revenue optimizing systems, asking them to invest their invaluable time in something which is non-core to their medical efficiency could ultimately have an adverse impact on their efficiency for medical care. Therefore, there seems to be a considerable propensity to outsource Medical Billing Management, which is believed not only to improve reimbursement rates, but also enhance the quality of medical care to patients.

Yet, amidst numerous service providers, the selection can often be tricky. Faced with such situation, physician should invariably conduct a SWOT Analysis of the shortlisted services providers for making judgment in favor of an apt service provider. Prior to soliciting a medical billing service provider, there is an underlying need to establish your service provider’s ability to provide comprehensive service package, comprising:

  • Claim generation and submission
  • Carrier follow-up
  • Payment posting and processing
  • Patient invoicing and support
  • Collection agency transfer services

Further, you should also be able to figure out its ingenuity for amicable phasing of the billing management procedure – traversing a sequential pattern, such as credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.

Additionally, the following criteria should usually form the basis for selecting a medical billing management company:

  • Ability to provide highest level of service, which proves its capacity to pursuing denied claims, billing follow up, complying with regulations, and reporting and analysis of reimbursed claims.
  • Substantial Industry experience, which validates its expertise in
  • ICD9, CPT4 and HCPCS Coding
  • Medical Terminology
  • Insurance claims and billing, appeals and denials, fraud and abuse
  • HIPAA and Office of Inspector General (OIG) Compliance
  • Information and web technology
  • Reimbursement
  • Penchant for using the latest technological platforms, which verifies its sufficiency in EHR, billing software, coding technology, and online data repository service for data storage and dissemination across the network for interoperability.
  • Pricing model adopted, which measures its flexibility to adopt result-oriented or project-based pricing systems.
  • Receptive to new clients, which establishes its receptiveness to take on newer clients without any apprehensions.

While these checklists are of immense utility to physicians seeking outsourced billing management solutions, the requisite comprehensive evaluation, yet again, involves time-factor of invaluable significance. Therefore, when faced with such daunting task involving intricate evaluation,

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), whose comprehensive and proven Medical Billing Management – complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards, should offer an easy recourse to instant selection.

 

Category : Revenue Cycle Management