It’s all about Billing, Billing, Billing – Ringing in the cash revenues!
Here are some mind-boggling Medical Billing facts that affect healthcare revenues impacting the Revenue Cycle Management Process and medical billing practices.
The total market size of outsourced revenue cycle management (RCM) services has already reached $5 billion, and it is estimated that escalating financial pressures will further expand the market
The average US doctor spends one-sixth or 16.6 percent of his or her working hours on administrative tasks alone and includes billing rechecks
It is estimated that doctors in the U.S. leave approximately $125 billion on the table each year due to poor billing practices.
And that about 25 to 30 percent of lost medical practice income is due to improper billing.
Did you know that it takes as many as 250 people- from the nurse to the medical coder — who could be involved in generating just one bill!!
And despite the technology and processes and workflows, some experts opine that as many as 80 percent of the medical billing contains errors!
And a recent survey conducted in the United State revealed that the single largest yet avoidable reason for about 78.2percent of all Insurance Claim Denials is because of – incorrect patient demographic information.
Added to this, approximately 30 percent of all claims submitted to an insurance carrier on the initial submission are denied whether they are correct or not. Insurances workers do this because only less than 25 percent of medical practices appeal their claims denial in the USA!!
30 percent of the 15 billion claims submitted annually in the US are denied
- Of the aforementioned 30percent, 15 (675 million!) are never resubmitted
Medicare denies about 11percent of all claims submitted
- Of the aforementioned 11percent, 40 percent are never resubmitted
But, there is always a light at the end of the tunnel
- According to CMS data, 65percent of the claims carriers reviewed on appeal resulted in an increased payment to the provider
- 70-80 percent of all appealed claims eventually get paid
Did you know that over $5.6 billion in health information breaches cost the healthcare industry annually
Benefits of Partnering with a trusted medical billing partner have experienced an improvement in the following key performance metrics:
- 73 percent of organizations realized a reduction in A/R days and achieved higher collections.
- 59 percent observed a reduction in the number of denied claims.
- 59 percent of firms reported access to better reporting and analytical tools
Top 7 Reasons Healthcare Firms Outsource RCM (PricewaterhouseCoopers)
1. Lower costs – 76 percent
2. Gain access to talent – 70 percent
3. Outsource activities that others can do better – 63 percent
4. Increase business model flexibility – 56 percent
5. Improving customer relationships – 42 percent
6. Offering new services to the customers/market segment expansion – 37 percent
7. Geographic expansion – 33 percent
Billing Practices
Physicians can charge almost $20 for a simple pen used to mark a patient’s skin for surgery to a 500 percent markup for a single over-the-counter pain reliever (and each subsequent pill dispensed)
Two doctors who ran a mental health facility billed Medicare for an enormous sum of money. These physicians had been billing for therapy that was never performed. Medicare paid these doctors for the intensive outpatient treatment they were supposed to be administering. Over a period of five years, these doctors managed to bill Medicare for $97 million dollars before being brought up on charges.
Despite all the scams & fraud, the Bureau of Labor Statistics expects employment of all billing clerks to increase by 11 percent from 2012 to 2022, which is about average growth.
Demand for certified medical billers may even outpace that for billing clerks in other industries, due largely to the aging U.S. population and the fact that the elderly access the healthcare system more frequently than other age groups.
Many institutions are looking to strengthen their financial management arms – 28 hospitals and health systems posted job listings seeking RCM expertise for their organizations in July 2016 itself!
May the cash registers jingle all the way…