P3 Healthcare Solutions

The medical billing services operations in the USA have dramatically changed over time. The billing staff and the insurance companies wrestle with each other around payments of the physicians. Payment process has become complex with the never-ending workload on medical billing outsourcing companies. To make things worse, the rate of claim denials has jumped up along with the denial write-offs.

A study report reflects upon the years from 2011-2017. During these years the volume of denied claims increased by 79% for an average hospital. It means that there were fewer timely reimbursements that put financial pressures on healthcare professionals in general and not only the physicians.

The constant tug of war between hospitals and insurance setups for the rightful payments is not a good omen for the industry. Therefore, we have to do something to bring stability, reliability and keep the trust factor alive amongst the Americans for concerns with the US healthcare industry.

For starters, we need efficient AR management as an immediate solution to this problem. If we pursue better accounts receivable, the pressure on the revenue stream reduces automatically.

Poor Denial Management – A Major Cause of Failed Cash Recovery   

Generally, AR specialists within medical billing services manage accounts receivable (AR) to the best of their abilities. However, sometimes they don’t pay enough attention to the aged medical claims. According to an estimate, around 65% of the denied claims remain incorrect with mistakes and never see the light of an insurance company. That indicates how follow-up services have failed to deliver to the revenue cycle management process.

Over-aged medical claims typically of above 300 days are on their way to a write-off. It is one of the alarming reasons behind decreased reimbursement rates in the industry.

A Setback to Revenue Cycle Management

The decrement of profit margins, the increment of denial volume, and the restricted capacity of medical billing services do not add value to accounts receivable (AR).  Hospitals are to take direct steps towards minimizing these problems. Billing staff should be capable of professional follow-up services for those claims unattended for 90 days or more.

AR management instructs the whole team to re-analyze denied claims. However, claims which reach beyond AR-threshold age have to face write-offs.  A recent research study shows that 30% of the hospital facilities have accounts receivable of around $10 – $50 million. It is more surprising that 6% of physicians have pending payments of more than $50 million. Imagine the amount of money they can recover if denied claims go through resubmissions within the specified period.

There are many other reasons for the setback in physician revenue, however; not having proper follow-up services tops the list.

Gear Up to New Revenue Opportunities

Despite all the problems, it is a good sign that stakeholders of the industry have started to realize the problem. There is a gradual shift towards a better healthcare system by overcoming the AR issues. Billing companies acutely check the claims for errors and do rigorous follow up after old age claims.

Hospital staff, on the other hand, gets to focus on the patient and the procedures at hand. There is no need for them to worry about the creation, submission or resubmission of medical claims. They depend on medical billing outsourcing for the finances involved in their practice.

What Is Your Role As A Medical Billing Outsourcing Company?

A mature medical billing outsourcing company helps in a number of ways contributing positively to your goals as a healthcare professional. They not only increase your revenue as a whole but also decrease AR against your TIN. Furthermore, you are safe in terms of collections at the end of a proactive billing session.

Three Functions of a Billing Company

• It establishes a systematic approach to AR management for 100% claim resolution.

• It optimizes claim-processing methods to minimize errors

• It evaluates performances to check the transparency of the revenue cycle

Those efforts if done sincerely increase cash flow, reduce bad debt reserves, and fewer claims end up on the write-off destination.

Pursuance of a Zero-Tolerance Strategy against Write off Claims

Medical billing services should fill the cracks leading to write-offs. There’s a need to follow-up claims after every 30 or 90 days as a company policy. Going forward, if nothing happens, they can launch their ‘final effort teams’ upfront for uncollected claims.

Through the final-effort payment collectors, hospitals make sure to collect payments and deal with unverified payments in accounts receivable.

Search for the Root Cause of Denied Claims

Hospital personnel don’t have the time to determine the underlying reasons for unpaid claims. Billing companies can use system automation to find those reasons. It can help segment the denied claims according to the type or size of the error. This way, the precautionary measure can lead up to higher claim acceptance rates in the future.

What about Pending Payments?

Achieving a reasonable rate of cash recovery serves to provide efficient revenue cycle management. By implying a strong accounts receivable strategy, hospitals can get their due amount on time without any write-offs.

If you face the same problem of not getting what you deserve for rendered services, consult a professional healthcare IT firm as early as possible. You may experience a positive increase in your payment structure, thus speeding up the revenue cycle.

Follow us on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/ for professional medical billing services, expand your opportunities with fewer write-offs, and add more juice to your payments.