Insurance companies are increasingly inventing complex and new sets of rules for the medical procedure which has resulted into loads of denials and underpayment. Doctors and pharmacists are increasingly finding it difficult under the ever-changing federal laws for practice and drugs. The recent data will also show the plight of doctors.
Only 70% of the claims submitted are paid the first time according to the research Center of Medicare and Medicaid (CMS). The other 30% denied claims are either lost or ignored or never resubmitted. Out of those 30% denied claims 60% claims are never resubmitted.
What’s more shocking is the fact that doctors aren’t even paid in full according to their contracts. The medical group management association (MGMA) estimates that payers are currently underpaying the doctors by almost 7% to 11%. So on average, a doctor is not paid 25% of the amount that they have earned by treating a patient. This has translated to a total of $125 billion left on the table by the American Health Care industry.
Currently, doctors are shifting away from private practices as sustainability on lone basis is difficult with the requirement of software and extra staff for revenue cycle management.
With unpaid and underpayment doctors are looking for innovative ways to approach the problem. Here are certain methods to use in which you can amplify your ARs.
Claim submission management
If the submitted claim is not paid up in the first submission cycle the likelihood that the claim will ever get paid also reduces drastically. One of the best methods to get paid when the claim is submitted is to identify the potential claim which might be rejected.
Identifying such claims using an intelligent engine that constantly adapts and updates according to the rules and regulations of payers.
Using a software solution to constantly update and adapts after analyzing all the denied claims of the insurance company from all doctors.
One of the major problems with doctor’s payment is the underpayment. Now every doctor has a different contract with each payer or insurance company.
Now if four people come in with the same medical condition that needs the same doctor but each patient has different medical insurance then each insurer pays a different amount.
For this, you need software to track all payments. You can allow the contracts which pay full payment or even used to predict future collections.
Daily ageing of receivable
Traditionally receivable are tracked based on a 30-day increment period. But now as each payer has a different schedule, they will need a different set of actions. Two receivables which are 30-day old could require different actions from different payers.
With no 30-60-90 days plan being followed manual monitoring is needed for each claim. Practice can improve their days-sales-outstanding (DSO) with constant monitoring of all claims. The sooner practice follow-up with insurers the better chance you have of being paid than the claim being lost or ignored. Practice management software can help keep track of this without manually doing this work.
From patient appointment scheduling to collecting reimbursement from payer requires a tedious process of documentation this all can now be done electronically with software. The manual work makes the process error-prone and less efficient.
Every mistake in the documentation will be added on till the claim submission creating a bumpy ride for AR. Most efficient medical practices use practice management software to automate workflow management.
Top-notch software will schedule the patient visit for you, look through the claim system for you, and track all your AR from outsourced billers and coders. Send customized emails to patients informing them about their appointments.
Modern health care reporting and analysis
The modern health care industry is much based on making the right decision which can only be achieved with complete access, and well-organized data. Data can be your accomplice for growth if analyzed with purpose. Modern healthcare trends are important for achieving revenue growth. This can only be done when you have all your data at one place.
It is important for being able to mine data when you are on the go, so you can create reports and have live analysis. The process of data mining can be eased using practice management software providing you with UX to access data.
Things you should look into your practice management software
1. Automate Work queue
The work queue will simply automate and update as your front desk will update the patients’ appointment. The doctors can reschedule or provide confirmation on the same appointment. This requires minimum paperwork and more freedom for doctors to operate.
2. Specialty routing
Specialty routing is a very important task for hospitals which deals with complex diseases that require the involvement of more than one specialty. With specialty routing, all the doctors working on a patient can go through their medical history and reports without any manual paperwork using practice management software.
3. Advanced tracking
The physician should be able to track all the claims submitted and the duration of the submission. The underpayments and denied claims will provide an idea to the doctor about the insurance companies’ policy. Now many insurance companies are providing doctors with an online tracking facility which helps them to check the status of their claim. This also helps in planning the future endeavors of the practice.