How can A Medical Billing Service Help in Increasing Revenue at Your Practice?

Quality and cost have been inseparable. And, as U.S. health care industry is defined by new quality benchmarks, cost of administering medical services too seems be rising proportionately. While physicians continue to respond with appreciable clinical efficiency, they seem to have lost ways to find sustainable existence and growth. The existence of intense competition has forced them to operate at the most competitive prices, and off-set with volume. But, volume has failed to generate real revenues due to several reasons. As a result, many practices have either been forced to wind up operations or sell off.

One of the primary reasons for disproportionate revenues vis-à-vis actual volume is failed medical billing practices. Physician practices are either incompetent or lack the requisite infrastructure to take on the challenges of medical billing. The presence of multi-payer system too has not helped their cause. Medicare, Medicaid, and private payer environments pose unique challenges, which can be handled only by experts.

Sweeping health care reforms too have contributed to physicians’ billing woes. While reforms have generally been promulgated to streamline health care delivery and billing, physicians have found it tough to adapt to monumental transitions such as mandatory EHR compliance, ICD-10 coding, and performance-linked reimbursement regime or ACOs. There have also been instances of failed experiments on account of lack of expert or outside billing consultancy. The impact of these reasons is reflected in under-realization of claims, denials, and undesirable A/R days.

The solution to these inherent challenges lies in a full-pledged Revenue Cycle Management that can effectively mitigate under-realization of claims, denials, and undesirable A/R days. Physician practices that have been or likely to be impacted with revenue issues on account of internal billing incompetence and Federal Government’s clinical and operational reforms would do well to engage RCM consultancy that:

  • Increases revenue collections by ensuring patients are eligible for medical services and verifying pre-authorization prior to the examination
  • Allows tracking each stage of a claim or batch from first logged to posted payment
  • Vigorously follows up with unresolved claims issues and diligently appeals denied claims
  • Evaluates denial rationales and coding errors in order to establish follow-up procedures that maximize recovery rate
  • Employs predictive modeling to forecast future revenue streams and support cash flow
  • Is compliant with Medicare and HIPAA 5010 norms, and operates on certified EMR platform that satisfies HITECH requirements, qualifying physicians for performance incentives
  • Provides unparalleled transparency through comprehensive reporting and web-based tools that let you manage performance

It is also imperative that your Revenue Cycle Management (RCM) provider follows the tried and tested process, which comprises orderly execution of patient pre-authorization, eligibility and benefits verification, claim submission, payment posting, denial management, A/R follow up, reporting, and litigation management. – with credentials and expertise in managing revenue cycle processes for physician practices of varying sizes across the 50 states in the United States – holds the reputation of being a leading RCM provider with a comprehensive approach, encompassing  patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices), insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management (EOB analysis), AR management (insurance and patient), and financial management reporting.