Tackling the biggest problems with your billing
A recent Quest Diagnostics survey of more than 300 private practice owners, co-owners and partners provides insight into the greatest pain points related to physician billing. A closer look reveals opportunities for practices to potentially improve the financial health of their businesses while reducing the time spent handling claims, coding and educating staff about the evolving reimbursement landscape.
The varying requirements from payers pose a continuous challenge to physicians who find themselves facing tighter time constraints and declining reimbursements. It can be difficult to stay current with payer contracts, payment schedules and changing rates for commonly used codes.
Just knowing the correct nomenclature is yet another challenge, and the International Classification of Diseases (ICD) is a prime example. The move from ICD-9 to ICD-10 in fiscal year 2017 brought us from approximately 13,000 codes to more than 87,000. Navigating that many procedures and entries has proven daunting for many providers and their staff.
Many offices have a receptionist, an office manager and a medical assistant. When it comes to keeping up with billing and reworking claims, however, physicians reported in the Quest survey that it’s difficult for this limited staff to maintain the focus necessary, as they simply have too many other demands in a busy office. Frequently, the available employees lack the necessary experience and expertise to manage accurate and efficient billing procedures.
Adding appropriate technology to your practice can have profound effects on the well-being of your operations, allowing your workforce to focus on what they do best while you concentrate on patient care.
Getting a hold of the process
Increasingly, clinicians are adding practice management (PM) software that can reduce administrative tasks, such as scheduling and appointment reminders. Others are outsourcing the billing process altogether. Many practices are exploring revenue cycle management (RCM) providers, seeing it as an ounce of prevention for common revenue problems reported by those struggling with in-house billing.
Practices that perform in-house billing can benefit from properly integrated PM software to maintain patient communications while manually handling many billing procedures. It is imperative that someone responds to rejected and denied claims in a timely manner and that person also stay on top of regulatory changes.
A comprehensive RCM solution removes much of that burden from your team and may make for more timely reimbursements. These tasks would be handled by a service for a percentage of collections or for a subscription fee.
An RCM provider can also handle patient payment collection and claim reviews from insurance companies — common tasks within the revenue cycle — that can be a challenge for many practices. In fact, an enhanced RCM can help avoid issues before they occur. When these functions are properly combined with an electronic health record (EHR) or PM software, physicians can be alerted to potential issues, with the system flagging possible coding errors while still in the exam room.