Payer interaction plays a crucial role in ensuring that physicians receive payments in a fair and timely manner. Medical billers and coders who interact with payers need to stay current with major payers (insurance companies, employers, or the government) in order to make sure that errors and delays can be avoided. The changes in the health industry have made it necessary for the billing staff to stay abreast of the changes in policies and guidelines so as to be efficient and useful at the same time. There are many facets to payer interaction and the billing cycle such as efficient denial management, using correct medical codes, correct payment posting, and interacting with physicians about any changes in such processes.<\/p>\n
Coping with Changes<\/strong><\/p>\n The health industry in the country is undergoing unprecedented changes such as migration from ICD-9 codes to ICD-10, Electronic Medical Records implementation, advances in the health IT sector, and the way physicians would be paid in the future. Medical billers and coders need to be current and updated on these changes along with changes in the insurance sector. There are numerous ways of keeping abreast of such changes such as visiting insurance and government websites on a regular basis and making use of newsletters among other things. The best example of such a newsletter is by CMS which has started the “Medicare Quarterly Provider Compliance Newsletter: Guidance to Address Billing Errors” which addresses issues related to the most common billing errors in the industry.<\/p>\n The Tragedy of Errors<\/strong><\/p>\n The latest American Medical Association (AMA) report on payers points out that payers make mistakes in claims-processing to frustrate physicians and patients. The National Health Insurer Report Card gives details of various parameters such as accuracy, cash flow, payment timelines, improvement in claims cycle workflow, and administrative requirements \u2013 Prior authorizations which are distributed into 17 metrics. The major private payers in the country are compared in the report and include Aetna, Anthem, CIGNA, HCSC, Humana, Regence, and UHC. CIGNA has the lowest claims denial rates among these and Anthem, the highest. However, the average claims-processing error rate among these commercial payers is a staggering 19.3%, according to the latest report released in June 2011. This fact itself magnifies the importance of professional medical billers and coders who can successfully identify such errors by interacting with payers and ensure timely payment for physicians and health care providers.<\/p>\n Time<\/strong><\/p>\n The time spent by physicians interacting with payers, according to a study published in the health policy journal Health Affairs, is almost three hours a week. The cost of such interaction on a national scale is estimated by the study is about $23 billion to $32 billion<\/strong> each year. It is apparent that physicians cannot afford to spend so much time, money and effort in dealing with insurance companies and payers when more and more people are being insured due to the health reforms. The only viable option available for physicians is to outsource the whole process of interaction with payers to a third party that is experienced in this field. The reluctance of payers to reimburse physicians and the increasing workload of health care providers is making time a scarce commodity which is further exacerbating the problems faced by physicians and their staff.<\/p>\n