Increasing number of insurer errors in the US healthcare system provides a huge potential for reducing administrative costs and hence a great need for increasing the degree of accuracy.
Industry Standards State
- Health insurers process at least 1 out of 5 medical claims inaccurately
- Entire health insurance industry’s accuracy rate for processing and paying claims = 80%
- Claim processing expenditure = approximately $210 bn. per year
- Improving claim processing accuracy by only 1% = savings of nearly $777.6 mn. in unnecessary administrative cost
- Improving accuracy & completing getting rid of errors = saving of nearly $15.5 bn. each year
Unfortunately physicians and even patients end up covering the cost of these errors-
- Physicians time spent on health insurer red tape = 5 weeks annually
- Physicians revenue diverted on administrative tasks to ensure accurate payments = nearly 14%
Why health insurer errors occur?
Additional administrative costs due to initial payment inaccuracies include- multiple data entries, audits and collections expenses. Expenditure on each claim audited and appealed is generally anywhere between $14 and $25, hence making it imperative for physicians to avoid such costly errors.
How to avoid these costly errors? --- finding a solution!
The simplest solution would be a single transparent set of processing and payment rules for the health insurance industry resulting in increased savings, time and resources along with reduced paperwork. However in a multiple payer industry consisting of varied commercial payers this would be highly difficult to achieve. Few other steps physicians can take to remedy this condition to a certain degree are-
- A simplified administrative process with standardized requirements to help reduce unnecessary costs and requirement of maintaining a costly claims management system
- Adopt a high-quality electronic billing and payment systems that can cut down on processing errors and help avoid discrepancies that arise between charges submitted by a provider and an insurer’s catalogue of covered services and interventions
- Utilize the various HIPAA transactions available to perform successful low-cost audit and appeal processes
- Get constantly updated on the claims and billing processes, including the medical payment policies and procedures used by the person submitting the claims
Additionally, the physician can get familiar with -
- Various ways in which the health insurer can delay, deny or incorrectly pay a claim
- Ascertaining the claim’s status with the health insurer
- Usage of electronic HIPAA transactions to improve accuracy of claims submission
- Preparation and submission of an appeal when required
Finding a cost –effective solution with MBC
As it takes time and resources to help avoid these errors physicians may prefer opting for a specialized billing service. MBC billing experts apply the following to help reduce chance of errors-
- Administrative processes – help physicians with areas of administration which require up gradation and training and advice on the right software suited for their set-up
- Accuracy- regularly review and audit all the claims to ensure they are complete and accurate, to help identify and address in advance underpayments and denials
- Timeliness –process all claims on time besides applying updated medical policies to ensure least discrepancies with the payers
- Transparency- provide regular reports to physicians; besides constantly studying vital policies and information of insurer fee schedules and also utilize HIPAA compliance resulting in payment consistency and fewer payment disputes
- Insurer Contracts- with requisite industry know-how help physicians correctly identify a health insurer’s contractual requirements for claims submission, including associated fee schedules, medical payment policies, available claim edits and other payment rules prior to signing any contracts
- Regular follow ups & appeal- for all inappropriately paid and denied claims initiate a claim appeal, when appropriate, hence making an effort to correct the health insurer’s inaccuracy
MBC billing services = | Increased accuracy + reduced costs = | Increased revenue! |
MBC the largest consortium of billers and coders has been providing medical billing services for over a decade now; meeting necessary requirements for medical necessity and claims stipulations