Numerous US clinics profitability ratios have been depicting a downward trend and according to a recent physician survey, two thirds of the participants predict low profitability for the year ahead. This is not a positive scenario, and to change it first we have to consider the factors which are affecting the profitability of these clinics.

Percentage of billing errors majorly resulting from healthcare reforms-

Rejections 65%
Growing costs 57%
Affordable Care Act-related requirements 48%
Reforms in coding and documentation process, including ICD-10 44%

Below are few tips which may help reversing your profit graph upwards-

Physicians have been alerted by Medicare carriers, that wrong codes will no longer be paid. Many of four digit ICD codes are replaced by five digit codes and soon new set of ICD-10 codes will be applicable and entering the correct code has become almost essential.

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A modifier has to be appropriately used. As per industry experts, physicians can charge for both an office visit and a minor procedure, as long as they do enough work to justify billing for both, by using the correct modifiers.

Billing patient for consultation and for visits are two separate things. Proper codes have to be entered for either service. Charges for both services differ; a level three new patient visit pays $62 while a level three consultation pays $90.

Generally it is difficult to calculate the amount to be collected from co-pays. It is therefore always advisable to calculate co-pay’s before the patient leaves the clinic.

  • Use the most specific and recent ICD-9 codes
  • Remember to use modifiers
  • Don't confuse new patients with consultations
  • Collect those co-pays!

Overall the increasing billing pressures due to growing healthcare reforms and HIPPAA compliance norm leaves physicians with hardly any time to concentrate on healthcare service. It has been observed that almost 20% of their time is spent on Administrative functions which could be otherwise utilized for patient care. But hiring a staff and necessary software for billing process would also involve additional cost and then too there won’t be surety of error free reimbursements. Hence it is feasible to switch to a billing company to overcome reform challenges and for an ultimate billing solution as per your clinic’s requirement. provides medical billing services to every part of the healthcare industry across entire US. After investigating your clinic’s necessity MBC experts will guide you as to how to install the necessary software along with providing the option of outsourcing your entire billing process to MBC to ensure accuracy and increased profitability.

Published By - Medical Billers and Coders
Published Date - Aug-05-2013 Back

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