Revenue generation is a fundamental requirement for businesses to function properly. This is especially true when it comes to running successful healthcare facilities. However, the noble cause of treating patients is jeopardised by the ever-changing healthcare reforms.
In the United States, reimbursement from payers is the primary source of revenue for medical practises. The Affordable Care Act’s (ACA) Medicare and Medicaid plans provide the highest percentage of insurance coverage, followed by private insurance.
The Value of Medical Billing
The billing process is critical for medical practises to receive timely reimbursement. This process involves in-house staff members who are responsible for everything from appointment scheduling to transcribing, filling out the CMS-1500 claims form, submitting it to the appropriate insurer, working on denials, and following up with the payers until payment is made. It is a lengthy and time-consuming procedure.
• Incorrect Submissions Reduce Revenue
According to the statistics, the most common cause of late payments is incorrect form submission. It accounts for a significant 30 percent of the reason why physicians must wait for long periods of time to be paid.
• The billing process includes follow-up.
Many times, physicians must forego payment entirely due to a failure to follow up with payers. The staff is so overburdened with administrative and other tasks like coding and compliance that it is nearly impossible to spend at least 15 minutes on each phone call to the payer. Furthermore, if the accounts receivable (AR) falls into the next level of the 30 / 60 / 90 bucket, the chances of collection are significantly reduced.
• Payment Reporting and Posting
Posting the status of payments is an important part of the medical billing process, as it determines whether the practise has been reimbursed as expected and for each individual patient. The main goal of this process, however, should be to generate reports after analysing the reimbursement trend by insurance payer. This is useful in strategizing and planning submissions for various medical specialties.
Thus, if your medical billing cycle is well-connected and runs smoothly, you can be confident that you are collecting the most revenue for your practise. Nonetheless, it has been observed that practises of various sizes fail to streamline their billing cycle due to the many systematic steps involved, as well as compliance issues, resulting in many practises losing more revenue than before. In such a case, outsourcing the billing process to a vendor is the only viable option for cost savings and compliance with healthcare changes.
The healthcare industry is poised for rapid growth. The passage of the Affordable Care Act, as well as the accompanying Medicare/Medicaid expansions, resulted in a significant increase in coverage. An ageing population necessitates more care. Treatments for diseases and conditions that were previously untreatable are now possible thanks to advances in technology. Massive funds are being invested to cure cancer, treat AIDS, develop custom medications, and even create bionic implants to help people with limited mobility or vision. The medical field is dynamic, expanding, and only expected to grow in the future.
A few years ago, there was serious concern about a doctor and nurse shortage. Applications in those fields have increased as wages have risen. As technology takes over more general care, many new entrants are choosing to become highly specialised. However, all of these new doctors, patients, and programmes generate a massive amount of paperwork that must be meticulously processed in order to keep things moving. This step, known as medical billing, is critical and highly sought after.
Rachel Cartwright-full Vanzant’s name is Rachel Cartwright-Vanzant. For over 15 years, I’ve been speaking to healthcare organisations, What Are 3 Major Things Addressed In The HIPAA Law? and at national conferences. I’ve written resource books for legal nurse consultants as well as articles for peer-reviewed journals.