As the insurance reimbursement environment becomes increasingly stringent, the incidence of denials, delays, underpayments, and lost or ignored claims seems to be on the rise. Consider this interesting statistics compiled by the Centers for Medicare and Medicaid Services (CMS: 70% of claims are paid the first time they are submitted; 30% of claims are either denied (20%) or lost or ignored (10%); 60% of denied, lost or ignored claims will never be resubmitted; 18% of claims will never be collected. Therefore, it is obvious that physicians are losing a substantial portion of their reimbursements unable to keep pace with medical billing challenges. But it is not a thing that can be neglected as medical reimbursements happens to be the life-line of medical practices.
While it is certain that the dwindling reimbursement rates are the resultant of inadequate medical billing and RCM practices, it is also true that physicians have not been fully responsive to web-based medical billing and practice management software, which are deemed to be far superior to manual billing practices. The fact that physicians can expect today’s medical billing technology to adapt to situational demands of medical billing reimbursements makes these web-based medical billing and practice management software indispensable to resurrect the dwindling reimbursements, which on an average aggregate to $125 billion yearly.
The first step in claim realization begins with accurate coding without scope for denials. Therefore it is imperative that physicians’ medical billing is intuitive enough to forecast and adapt in such way that would negate the chance of denial. But, because billing staff’s ability is limited, billing software with proactive rules engine has become more reliable. The significant thing about proactive rule engine is that it can automatically identify claims that are likely to be denied and correct them before being submitted for claims. Consequently, you can expect an increase in first pass resolution rate, acceleration of claim realization, and considerable reduction in workload for your in-house staff.
It is strange yet true that practices are reimbursed far below than what they are entitled for. Moreover, the reimbursements tend to be different despite the procedure being the same. While these discrepancies in reimbursements rates may emanate from payer contracts, it is highly unlikely that physicians will be able to figure exactly which payer contract is yielding underpayment. Fortunately, they can turn to software that can automatically compare the actual payments received with the payments specified in each payer contract, and alerting them when discrepancies occur. Such software module that is capable of tracking discrepancies in reimbursements will eventually augment collection rates, promote physicians’ efficiency and growth, and make accurate financial prediction.
The efficiency of claim realization has always hinged on how best physicians handle A/R Management. Time factor is the crucial thing in A/R Management: less time your claims stay in A/R bracket, better your practices’ financial health. But, of late physicians have been complaining of their A/Rs consuming more than the admissible time limit of 90 days and eventually ending up as bad debts. Therefore, it is imperative that physicians respond to the challenges in A/R management through seamless integration of claim generation, submission, follow-up, and remediation. Electronic medical billing – built on sound Practice Management systems – promotes harmonious integration of claim generation, submission, follow-up, and remediation aimed at speeding up the Account Receivable Cycle.
While physicians contemplate on turning around their practices’ revenues with new found technological platform (electronic medical billing), cost and method of installation may be matter of immediate concern. Assistance from a medical billing service to help install an electronic billing system integrating with the areas most required by the practice and handle the A/R will help improve collections. Medicalbillersandcoders.com – by virtue of being credible, competent, and self-sufficient in offering cost-effective – comes across as a leading name. Its strategic partnership with leading PMS and EHR vendors lends its medical billing services the technological edge.