According to research sources, poor medical billing practices in the US alone are estimated to leave approximately $125 billion on the table each year! The reasons for this can be embedded in an inefficient Revenue Cycle Management (RCM) process, which begins right from the front desk verification of patient’s insurance documents, through the proper coding and billing cycle, submission of the claims, follow-ups of the claims with insurers and the resubmission if rejected and or denied the claim. It is this claims process that is most critical to any medical services or healthcare provider and can have a major impact on their financial performance.
Imagine the consequences on the profitability of your medical practice if you experience a claims rejection rate of 10 percent on just the first pass! And, what could ensue for complex patient visits, if the rejection rate climbed higher? On an average, a claim refilling costs up to $25 per claim (few industry sources put an even higher figure), which can make claims adjudication a very expensive proposition. Hence, the better optimized your claims submission workflow process is, the better your first-pass payment rate, and the shorter your billing cycle will be. Sources have also estimated that for group practices the benchmarking average rejection rate is approximately 5-10 percent.
Reports have estimated that up to 80 percent of medical bills contain errors. These errors could be as minor as a misspelling of a patient’s name, not verifying if the patient is eligible as per the insurance coverage to even a transposition of a code digit. Every person on the staff needs to be vigilant about whatever has been entered into forms- more the automated ones as the mistakes can carry forth and bypassed very easily. Even the physician’s documentation needs to be clear and precise for the coders and billers to easily verify and make the appropriate data inputs.
Moreover, the complexities prevalent in the healthcare regulations especially of medical insurance and the processes employed in the way that medical services are billed and collected are often counterproductive in getting claims responded to with speed.
Points for an effective error free claims processing to improve profitability for your medical practice:
An efficient front desk staff who are well trained & knowledgeable with the intricacies of both, Medicare as well as different insurance payers and their coverage, is very vital in the initial stages of employing an error-free claims management process.
The next step would be to engage well credited coders and billers who are up- to-date with the complexities of the ICD-10 coding systems and appropriate modifiers to be employed.
Billers should be vigilant when examining and processing the claims as they are the most important elements of your claims management workflow.
Claims staffers who can rigorously conduct the follow-up of claims and provide well- documented
proofs in case of rejections and/or denials
Either in-house or outsourcing of the claims processing system can help speed your claims reimbursement to help profitability to your medical practice
It is hence very critical to carry out medical billing and coding services with accuracy, as denial or rejection of the claims depends upon data inaccuracies and significant coding errors.