Family practice has traditionally ailed from under revenue collection for various factors related to billing and coding, like modifier omission, lack or inadequacy of supporting documentation, underscoring and claim submission. These may look like minor errors but their impact on revenue is anything but minor.
For example, given the rates at which Medicare pays family physicians now, for underscoring just one level for four visits in a day, a practitioner could lose to the tune of $8.396 in a year.
Also,family practice treatments involve care components that are often handled by outside agencies, which are included in the same treatment episode; hence outside agencies credentials affect the final revenue outcome of a treatment. Laboratories performing tests is a point in case.
Following are the reasons how a diagnostic test can affect the revenue outcome of a treatment–
- CLIA mandates that all laboratories should be properly certified to receive Medicare and Medicaid payments
- Additionally, there are different codes for tests conducted by CLIA-waived laboratories
- Also, it requires sound understanding and experience of billing and coding to optimize collections for CLIA-waived tests, like UA, glucose finger sticks, injection administration fees, etc
Below are the broad areas that can help address the challenges-
- Sound knowledge of family practice billing and coding which will help negotiate intricacies like how much and how to code patient visits and how to avoid underscoring them
- Sound documentation which will help support coded care services
- Understanding of factors like laboratory tests from billing and coding perspective, the ones that have Medicare coverage and ones that don’t and how to optimally code them
Additionally, family practices face frequent cuts in Medicare payments further tightening their financial situation. To offset these effects many family practitioners are joining ACOs; albeit not without its accompanying challenges, like
- Mandatory EHR
- PQRS and ICD-10
All medical disciplines have turf-specific reimbursement challenges that affect revenues; but what makes the revenue dent on family practices a little deeper is that family practices are mostly small to medium sized (clinics or just an individual practitioner) outfits with less financial cushioning. Medicalbillerandcoders.com, flexible billing and coding service modules are designed such that they can meet all types of billing and coding needs regardless of size or kind of operations.
MBC’s Revenue Management consulting services can help you by assessing your in-house revenue management cycle. Our experts ensure that there is sound coordination between various components of healthcare facilitating smooth flow of medical data for ACO operations and otherwise. We also provide sound documentation to support your claims. Our team will additionally identify gaps in your process and address them by replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.
We can train your staff in-
- Handling complexities of E&M billing
- New billing and coding challenges like EHR, PQRS, and ICD-10 especially if you are looking to or have already joined an ACO
Medicalbillerandcoders.com, the largest consortium of billers and coders present in the 50 US States, has been helping several small to medium size family practitioners with its Outsourcing services. We handle the gamut of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups. However, you can also pick and choose such parts of our services as meet your specific billing and coding needs, like only claim submission or post-submission follow-up etc.
FAQs
1. How can billing and coding errors affect family practice revenue?
Errors like modifier omission, inadequate documentation, or underscoring can lead to significant revenue loss, impacting a family practice’s financial health.
2. Why is CLIA certification important for lab tests in family practice billing?
CLIA certification is required for labs to receive Medicare and Medicaid payments, and coding correctly for CLIA-waived tests can help optimize collections.
3. How can sound documentation improve family practice reimbursements?
Proper documentation supports coded services, reduces claim denials, and maximizes reimbursement by providing clear evidence of care provided.
4. What are some challenges family practices face in joining ACOs?
ACOs require EHR implementation, compliance with PQRS, and adapting to ICD-10 codes, which can add complexity to billing and coding.
5. How does MBC support family practices with billing and coding needs?
MBC offers flexible services, from claim preparation to post-submission follow-ups, and provides staff training to handle new billing requirements and reduce revenue leakage.
