Healthcare is an evolving industry and the tribulations faced in this volatile industry are immense. There are new diseases being discovered which have to be diagnosed and battled. With technological advancements, it is observed that physicians are spending less time with patients and more on the billing aspect.
Hospitals are not paying as high as they would in the ’90s for physician practices. Physicians are under constant pressure to get paid for the work they do. As per the Affordable Care Act (ACA), the reimbursement models are shifting from fee for service model to value-based payment systems where value is attached for each of the services rendered. Some of the new, promising methods remain firmly grounded in fee-for-service payment but provide few new incentives to modify the content of care. Other methods represent a more fundamental shift away from fee-for-service, but at present do not work by providing payments based on assessed value using performance measurement. Rather, they largely are designed to alter the payment incentives that physicians and other providers respond to, with the goal of improving value.
Being a physician, the prime focus remains patient care, and simultaneously looking after the billing and coding could become taxing. Slight ignorance on the part of the doctor could result in lost revenue.
Denial of claims is one of the biggest reasons for losing out on revenue. Some common reasons for claim denial are expiry of insurance plan, incorrect information provided, modifiers missing in the claim form, etc. Hiring an in-house team could be an added challenge, with staff issues to be resolved and looked after. The mandated switch to ICD-10 this October will be inviting more pressure on the physicians in order to make sure their practice experiences minimal errors and denials and maximum documentation.
Physicians are now taking steps towards increasing their revenue. Those physicians who are unable to manage their administrative tasks are outsourcing them to billing experts who ensure no stone unturned in collecting the revenue for physicians.
Please share your thoughts about what other reasons could be responsible for the loss of revenue and what steps can be taken to curtail more losses.