Initial Hiccups in a New Practice!!

As a physician, most days have their ups and downs. A physician’s profession is to help heal and work with the sick. However, besides working with patients they also have to deal with a lot of administrative processes. One of the major jobs is handling the medical billing and coding of a patient’s illness, which helps bring in reimbursements. However, this is not always smooth sailing. Let us see how a bad day can make the physician drop dead if they had the chance!

In walks, a patient and the front desk person are on leave. This makes it necessary to note all the details of the patient and not just the symptoms of the illness, but insurance coverage details as well. Are you aware that with the new health reforms people who don’t pay their premiums lose coverage after 90 days? And the physician may not get paid? So besides the medical expertise, physicians need to be aware about the coverage plans.

Moreover, besides the in-house coders and billers who need to be updated with the ICD-10 coding system, the physician, too needs to be aware of the codes as the descriptive documentation now needs to cover those extra codes being brought in. If those are missed out by the coders, you could lose reimbursements due to claim denials. What happens if a claim gets denied?

It is the physician who will need to backtrack, look at notes, check and match with the coding and billing, see what is missed or overrated, as that could go to the fraud department for overbilling. And National studies have estimated that the cost for waste and inefficiencies in healthcare expenditures to be as much as 30%.

Following are a few tips to help deal with such a harrowing situation that will help improve physician productivity and make your practice efficient and thus generate good revenues.

1. Take responsibility:

Every staff member has to realize how they contribute to the revenue cycle. Any error in billing or coding can have a negative impact on the revenues.

2. Know your facts and upgrade your knowledge:

Awareness and knowledge of the changing healthcare reforms, Insurance coverage plans, coding details, etc need to be updated regularly among the staff.

3. Scheduling Inefficiency:

Inadequate planning, over-scheduling, and harassed staff can lead to a loss in productivity. Adequate training of the front desk and understanding the health cycles will help create a better process and avoid bad days.

Efficiency and Productivity will earn you more footfalls, i.e. happy patients. Knowing the insurance rules & regulations, and well-documented coding of the patients symptoms will help decrease your claim denials and faster reimbursements into the kitty.