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Phases in Medical Billing Services for Podiatrists

There are several medical specializations and for each specialization, there is a certain set of rules and codes in medical billing services.

Not every medicine field has the same diagnostic and surgical procedures. Similarly, medical billing and coding guidelines and techniques are different for each specialization. Same is the case with podiatry. When a medical billing company claims for podiatry services, they work on a special dedicated plan.

First, learn what is Podiatry?

Podiatry is the branch of medicine, which is concerned with the diagnosis, treatment, and study of diseases and disorders of the foot and lower extremity. Treatments are related to regular healthcare treatments, neurological, metabolic, and other underlying issues along with injuries, wounds, and infections.

Rules Regarding Medical Billing Services for Podiatrists

The Center of Medicare and Medicaid Services (CMS) has defined rules and procedure for each discipline of medicine. There are clear instructions of what should be covered under an insurance plan for podiatrists. New medical billing outsourcing companies can take notes from their official website.

Insurance Don’t Pay for Non-Medically Necessary Services

Under CMS rules, insurance companies will only pay for medically necessary foot care services.

A regular foot care service falls into the following categories.

  • Additional
  • Mandatory
  • Supplemental
  • Optional supplemental

What Exclusions Are Involved in Podiatry Medical Billing?

There are certain cases in which fighting with insurance companies for reimbursement is straightaway lost war. There is no point in sending claims for the following cases.

Straight away rejection cases include:

  • Initial care service
  • Existence of metabolic, neurologic, or other peripheral vascular diseases
  • Mycotic nails
  • When a patient is already receiving primary healthcare
  • Dislocation of ankle joint
  • Subluxation of structures within feet
  • When a patient wears orthotic shoes
  • When a diabetic patient wears special shoes

To higher the acceptance rate of medical claims, medical billing services should precisely state the name of the podiatrist, who diagnosed the disease. Moreover, the severity of the condition should be reported not just the diagnostic procedure.

New medical billers and coders often get lost in the maze of instructions and guidelines. Medical billing for podiatry indeed requires a great level of accuracy as insurance companies don’t pay for these services very easily.

However, with little care, necessary paperwork,  just like we do, there will be no problem in the claim submission process. We, P3 Healthcare Solutions, Ontario, CA have carefully devised medical billing methods for different specialties and offer specialty-specific services to physicians.

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4 Tips to Improve Patients’ Payments via P3Care, Ontario, CA

Medical billing companies have the responsibility to make physicians’ survival easy by collecting reimbursements. Insurance plans are of many types, and in case of private healthcare plan; patients are required to pay deductibles from their pockets.

The healthcare expenses in the U.S have already reached a limit; where even a middle-class patient finds it difficult to clear off his bills. Therefore, getting deductibles and co-payments from patients prove to be a hectic job for medical billing services.

Apart from the strict rules of insurance companies, medical billing companies have a hard time collecting patients payments. Then, how can they ease their burden and reduce accounts receivable (AR)?

It might seem like an impossible job, but via 4 simple tricks that P3Care has learned over the years, medical billers can achieve success in this regards.

  1. Medical Billing Companies Should Allow Multi Channels Payment Methods

Suppose you and your friend have to pay some bills, it is not necessary that you both will pay through the same method. Maybe you like paying cash and your friend might like to pay via credit card.

According to research, customers make payments based on the fact that what is convenient for them. Same is the case with patients. When there are multiple payment methods, patients can opt for the most suitable method. Medical billing companies should encourage clinicians to have a flexible payment method. Otherwise, hospitals would be missing out some major revenue.

The Omni channel approach of payment model doesn’t restrict patients with minimum access to choices. It will also have a positive impact on the patients’ satisfaction level.

  1. Adopt Automated Payment Method

Automated payment refers to paying bills on a predetermined date. This payment method ensures secure and confirmed payment by the patient. As the patient already knows about the scheduled payment, medical billing companies thereby, need lesser staff for payment collection.

Generally, via this method, patients make payments on time, especially the ones with high deductibles. Moreover, the billing staff can reduce unnecessary expenditure. For Instance, on paper files.  Automated bills also help to reduce the efforts for follow-up services.  The front desk of medical billing companies doesn’t have to go after each patient for payment. They only have to decide upon a specific date, and the process goes by easily, other than in exceptional cases.

P3 Healthcare Solutions being among the best medical billing companies in Ontario, CA recommends that medical billers should inform about the total payment while deciding upon the payment plan to the patient, rather than asking for a fee each month.

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  1. Educate Patients about their Payment Responsibilities

Medical billing services should be clear about one thing; you can’t expect patients to pay deductible and co-payments at once, particularly, if they’re in significant numbers. Nobody likes such surprises. Therefore, a better approach is to educate patients in the early stages of their financial responsibilities.

It is also proven from research that around 91% of patients like to know the complete payment model prior to the visit. Clinicians in association with the medical billing service should map out every payment detail in front of the patients. Only this way, physicians will manage to increase revenue for themselves.

It also brings forward a good reputation of the physicians and makes patients trust more on the medical practice.

  1. Ensure HIPAA-Compliance in Payment Model

Patients’ data security is everything. However, healthcare data is always at risk. We have seen many scenarios where data breaches lead to huge revenue losses. While creating medical claims and collecting payments from patients, medical billing staff works with sensitive information, be it, credit card information and healthcare records.

Taking exclusive measures to protect the misuse of data requires the allocation of dedicated resources, which some companies might not be interested in. However, this step can’t be neglected. Besides streamlining other billing operations, patients’ data security also adds to revenue increment.

Moreover, designing a comprehensive security plan as per the Payment Card Industry (PCI) standards don’t necessarily require a huge investment.

P3Care is one of the renowned names in the medical billing world.  We have worked for several years in this industry and increased revenue for many clients. By implementing above-mentioned tactics, we have managed to generate fruitful results. Hopefully, it’ll result in the best possible way for minnows of the billing industry.

5 Things Every Medical Billing Company in Ontario, CA Needs to Do!

If you own a medical practice or work in a hospital, you might have hired a medical billing company for claims submission. Whether you are a reliable medical billing company in Ontario, CA or not, the discussion today is important in the general sense.

If the respective medical billing service is an established one, there’s a 100% chance that it would have overcome all the loopholes in its medical billing process. If not, you should be a little careful while hiring medical billing services.

It is observed that up to 20% of medical claims are denied due to poor medical billing practices. As a medical billing company, you surely don’t want to have a bad reputation in the healthcare industry. So, given below are few tips that you might want to follow. It will help you work better in favor of clinicians.

  1. Focus on Training Medical Billing Staff

If your medical billing agency recruits medical billers and coders, who have little or no experience in the respective field. You should immediately do something to train your staff because it might be causing major revenue loss for physicians.

Without the proper knowledge, medical coders are unable to choose correct codes for the diagnosis. It is possible that they might be using the wrong modifiers for treatments.

Medical billing services should properly train employees as per the CMS guidelines to create and submit medical claims. So, there remains no chance of error.

  1. Tighten Up Your Follow –Up Services

Medical billing services need to interact with patients and physicians simultaneously while creating medical claims. It is a lot of work. Reporting accurate diagnostic and surgical procedures along with double-checking them takes a lot of time. Moreover, they also get faxes and emails every day in bulks.

When there is so much to do, things can pile up. However, despite a busy schedule, it is compulsory to keep a check on the submitted medical claims. Know about the claims’ status that either they are in process or have been denied. It has a crucial impact on revenue cycle management. Also, the follow-up services are time-specific, meaning, you can resubmit denied claims within a specified time. Otherwise, they get lost in the piles of papers.

Thus, professional medical billing companies never look down on the follow-up services.

  1. Keep Check on the Accounts Receivable (AR)

Some of you may not consider this point significant. But, it indeed plays an important part in the revenue generation.

Patients and even insurance companies generally don’t keep a check on the payments. However, medical billing companies should verify if a bill is fully paid or not. The unpaid reimbursements can take your revenue journey down.

If a bill is unpaid, you can always go for follow up services until accounts receivable are paid.

  1. The Filing Time Plays an Important Role in Revenue Generation

There’s a time limit for submitting claims to insurance companies. If a medical billing practice exceeds that time period, the claim will not add up in the revenue.

Even, you submit a claim within the time limit, there’s a chance that it might be rejected. Then, why take risk submitting it after time.

  1. Improve the Denial Management System

The percentage of denied medical claims is rising day by day due to strict rules of payers and governmental authorities.

Therefore, the medical billing and coding staff should be up-to-date with the latest news and criteria. Instead of ranting over denied claims, medical billing services should rectify errors and resubmit claims within time. An even better option is that the medical billing and coding process should be so transparent and precise to crash the chances of denied claims.

An experienced medical billing company straightens its billing process to maximize physicians’ revenue. P3 Healthcare Solutions is such a company that ensures high-quality medical billing for its clients.

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P3 Healthcare Solutions Named a Top Medical Billing Service by Clutch!

At P3 Healthcare Solutions, we know the world of healthcare is constantly changing. We aim to help our clients navigate the industry with our team of innovative, analytically minded experts. Specializing in a variety of equity and medical billing services, we are able to create stress-free and smooth processes for our clients, so they can focus on the patients. Due to our efforts, we have been recognized as one of the top medical billing services of 2019 by Clutch.

Located in the heart of Washington, DC, Clutch is a unique rating and reviews startup. Dedicated to B2B service providers, Clutch allows prospective buyers to connect with appropriate services providers via their listings. By analyzing industry data and conducting in-depth client reviews, Clutch has been able to award us with a 5.0 rating. We thank our clients for in participating in the review process. The feedback we receive is incredibly valuable. Check out our most recent review below!

In addition, we have earned a feature on Clutch’s sister-sites, The Manifest and Visual Objects. The Manifest is a business news platform designed to inform buyers of the marketplace via how to guides, state of tech news and industry rankings. Potential clients can find us listed among the top HR services on The Manifest. Visual Objects showcases the creative efforts of firms by displaying portfolios of their past work, along with a rating.

We are thrilled to receive a rating from Clutch. Our team works tirelessly to provide for our clients and we thank Clutch for recognizing us. Going forward we hope to continue to grow and develop as a company, all while expanding our client base. If we can provide healthcare administration support to your company, check us out today!

3 Qualities a Good Medical Billing Company Must Have

In what cases do medical practices think of hiring a medical billing company? Maybe they don’t have resources to spend on the denial management system. It may be possible that their submitted medical claims keep on coming back to them due to poor coding and billing techniques. Or, despite their utmost efforts, they don’t get reimbursements for all rendered services.

There can be many situations for healthcare organizations, where they feel themselves in troubled waters. Instead of ranting over issues, the least they can do is to hire medical billing services. The dream of getting the reimbursement rate up to the mark can only be true with a professional medical billing company.

Either the clinicians don’t have medical billing and coding experts or time and budget to spare for in-house medical billing; medical billing companies seem like the best option.

Medical Billing Company Helps Stabilize Cash Flow Efficiently

Medical billing services have the responsibility to get clinicians their rightful reimbursements. The goal is to improve revenue cycle management to such extent that physicians face no trouble incurring expenses.

Moreover, when physicians are relaxed from the tension of handling medical billing process, they focus attentively on their patients.

Whatever reason encourages physicians to consult a medical billing company, it is important is to research well about them. Where an experienced, medical billing service takes your revenue journey up the ladder, an immature and unprofessional one can restrict your growth.

Here are 3 qualities upon which you can choose the ideal medical billing company.

Specialty- Specific Billing Solutions

Experienced medical billing companies offer billing solutions, which are compatible with your practice. The documentation and billing codes are different for each specialty.

It is advisable to choose a medical billing company that has experience in your specialty. Their staff is often well familiar and trained with the related new trends and rules. They generally have an understanding of mistakes that can cost a lot and rectify them on time.

For Instance, P3 Healthcare Solutions is one of the leading names in the healthcare industry. Their experts have skills and training to create and submit accurate medical claims to insurance companies, and happy clients are the proof of their success.

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Working Experience in Medical Billing

There is always the first day for every company, but physicians can’t rely on any immature medical billing company, who don’t know about the healthcare industry. The entire revenue cycle management system of medical practice depends upon their performance. If you hire a minnow, you can’t expect to have 100% results.

Especially, when the healthcare industry undergoes several changes to facilitate patients and physicians, you can’t go to a company, which doesn’t have an accomplishment record. Such companies don’t know how to manage risk factors and often don’t perform HIPAA-compliant medical billing.

They may not have the latest technology or knowledge to create medical claims with 100% accuracy with poor follow up services. Then, why choose them and risk your revenue process.

 Adequate Medical Billing & Coding Staff

When you hand over your medical billing process to another company, make sure that they have adequate staff to handle your all burden.

A professional and experienced medical billing company not only knows how to handle the bulk of data, but they have proper infrastructure and equipment to implement strategies. They also are able to streamline operations and enable interoperability seamlessly. They have secured way of exchanging data between patients, physicians, and insurance companies.

Their error rectification system is faster, and they can help medical practices save a lot of money.

There are also some other factors that demonstrate the success of a medical billing company, such as, how well they communicate with their clients or if they train their employees with up-to-date skills and knowledge.

A healthcare organization hires a medical billing company to strengthen its revenue cycle management. It is indeed a great decision. If the chosen medical billing company has a good reputation in the healthcare industry, you can set an appointment with them and proceed to have an official contract.

Do you think that above-mentioned qualities should be important in a medical billing service provider? Or, there are some other qualities, that you deem necessary.

Let us know.

Forget In-House Medical Billing, Hire Medical Billing Company!

Hiring a medical billing company is a great decision. After all, physicians hand over all of the precious data to another company, and their reimbursements are based upon the performance of the medical billing service.

Particularly, this decision is very hard for small medical practices. They don’t have extravagant budgets to spend on medical billing. Efficient revenue cycle management remains their main objective. Moreover, their operations revolve around doing more with less.

Doing medical billing and taking care of patients simultaneously don’t do good for physicians. They often fall short in their efforts and don’t get reimbursements on time, making their survival even more difficult in the complex U.S healthcare system.

However, consulting a professional medical billing company as P3 Healthcare Solutions helps in saving lots of bucks while managing medical claims with accuracy and precision.

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Why Medical Practices Hire Medical Billing Companies?

If you’re confused while making the right decision for your practice, have a look into the following advantages. It may make up your mind in favor of hiring a medical billing service provider.

The Medical Billing Process Becomes Streamlined

A medical billing service makes sure that physicians get notified of all the accounts receivable (AR) and the received payments from both ends, that are, from patients and insurance companies.

Medical practices don’t have to dedicate resources, who spend hours in keeping track of payment posting for each patient. Hence, when they hire a medical billing company, they get a complete report at the end of a specified time and can plan revenue strategies for the future.

Medical Billing Company has an Integrated Practice Management System

With the advancement in the healthcare sector and the focus on value-driven medical services, medical billing system has also become advanced. Now, insurance companies don’t receive papers, but they receive claims electronically via practice management software. In addition to the introduction of electronic healthcare records (EHRs) in the healthcare system, data collection has become secure but complex.

The integration of practice management with electronic healthcare records is important. Otherwise, you won’t be able to create and submit medical claims in an organized manner.

Now, do you think that it is possible for medical organizations to have a fully integrated system? No. It requires separate dedicated staff to handle all of the system, which means more cost expenditure. However, medical billing services have experienced team of medical billers and coders on hand with an integrated practice management system.

Accurate Medical Claim Submission

Healthcare industry undergoes several changes each year. The changes may be regulatory or by the federal or state government. Nevertheless, keeping up with the industry norms and changes is indeed a tiresome task, which only a medical billing service can do efficiently.

Professional services have time and resources to make sure that medical claims are created with up-to-date knowledge and in accordance with the rules and regulations. Thus, by hiring medical billing services, physicians’ time is saved.

Increased Return over Investment (ROI)

Medical billing services submit medical claims according to the guidelines of the insurance companies. They have the time, resources, and expertise to process medical claims professionally. They don’t only submit claims but keep track of the claims with the denial management system and follow-up services.

Healthcare organizations who want to improve their medical billing reporting method should definitely hire medical billing services. After all, physicians work is to take care of the patients rather than scratching their heads over medical codes and bills.

Thus, the best option left for physicians is to consult a medical billing company and improve their revenue cycle management.

How Does A Medical Billing Service Benefit the Physicians?

Most practitioners are well aware of the advantages of outsourcing a medical billing company. However, some of those merits are of continuous vitality and worth a discussion.

Medical billing service to physicians’ matter when they suffer at the hands of EHRs! American doctors need a break and nothing better than a medical billing specialist to take you out of the financial mess.

Essentially, they reduce costs, increase collections, keep up with the coding updates, ICD-10 guidelines and are on the lookout for new codes. We will go on with their advantages one by one to highlight their tangible usefulness.

Decreased Staff Cost

Medical billing firm gives power to physician practices in terms of the doctor/patient time, personal time, and finally, the staff finds relief from accounting burdens. They don’t have to be meticulous in their CPT codes or around the complete coding mechanism of claims for that matter. It is a designated duty of the medical billing service to assign charges against procedures performed.

According to Barbara L. McAneny, MD, the American providers spend almost 20% of their medical revenue to ensure the accuracy of billing. They usually hire staff which is responsible for the collection of the authentic medical history of patients, entering specific codes and making claims.

If the doctors go with medical billing outsourcing, it will hugely reduce the costs and expenditures which they have to spend on their staff. The point is to choose cost-effective solutions and most companies are willing to provide just that!

Enhanced Transparency

One more thing is to look for a service with clear and consistent reporting mechanism. Revenue reports at the end of the week or month can either be satisfying or a red sign for the future. In other words, the process of transparency becomes prominent in case you hire a credible medical billing service.

It is a good deal to find software assistance, EMR training and guidance to increase your practice’s revenue under one roof. If you find a service with extra capabilities, which is rare, don’t let this chance slip away.

Transparency further materializes into the design of an accurate claim. To track the charges for each procedure and medication is difficult and demands focus. In the case of claim denials, providers have the right to ask for reasons and evidence in support of the argument. A good practice is to state the reporting requirements on the agreement forms.

Technology Commitment

A medical billing service company brings technology commitments with them. Purchasing the latest software for complex billing tasks costs are part of the investment. For a business which wishes to make a difference depends on generous spending. Quality is what matters to them. Therefore, a company with intricate design, infrastructure, and knowledgeable health IT consultants must be better at billing.

The software and latest technology tools are necessary for creating accurate claims and enhancing the revenue cycle management (RCM) process. Moreover, the experts also incorporate tools to improve patient reminders, online bill payments, and access patient portals in an elaborate revenue cycle system. The experts can make use of technology to generate expected results.

Increased Efficiency of the Work

There is an overall improvement in the ability to work for practitioners with outsourced medical billing service in comparison to those with an in-house billing team. The doctors who are running their independent clinics have administrative duties to fulfill. It is insane to burden them with additional workloads. It is as if we don’t want them to concentrate on patient care.

Ordinarily, the doctors with a medical billing service have more time for their patients and serve them with greater focus and care. Outsourcing enhances the efficiency of the practitioner.

Accurate Billing and Coding

It is the primary responsibility of expert medical billers and coders to code accurately. To be able to submit precise insurance claims to the insurance company is an actual art. Because, if there are errors, it is going to come back from the clearinghouse!

The insurance companies have a set time limit for practitioners to collect reimbursements. The billers ensure to collect claims on time. It helps in increasing revenue per year and the medical practice moves forward day after day.

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What do you think?

Attention! Medical Billing Companies are Charging More than Usual!

The Institute of Center for American Progress states that clinicians and insurance companies spend about $496 billion in the medical billing process. Either it is in the form of insurance or the cost incurred while hiring medical billing companies to create bills.

However, the alarming fact is that only about one-half of the huge money of administrative costs accounts for profitable billing. Moreover, medical practitioners and hospital staff also spend millions on providing value-driven healthcare.

For many time now, the debate is on that American healthcare industry is spending way too much on the administrative burden. Medical billing companies also suffer in this regard. They need to upgrade their systems to match the quality of administrative work.

What Should Be Done?

The high spending in healthcare with no particular outcomes has always been a concern. Thus, healthcare leaders have voiced the need for structural reforms in medical billing services.

Can We Expect to See Decrement in the Healthcare Expenditure?

As per the Revcycle Intelligence, it is estimated by the governing authorities that if no major changes are done, healthcare expenditure will increase by 5.5% on annual basis with an increment of 19% in GDP.

America spends double the money on healthcare as compared to other nations, and still, it is not among the top healthcare systems of the world. Provided these facts, you can get an idea of where healthcare will be going in the coming future.

Reasons for High Expenditure on Medical Billing Companies

As mentioned above, the major reason to blame is the administrative cost. It has also influenced the physicians’ performance as they are forced to spend half of their precious time in counting numbers rather than doing their actual work. Thus, when they spend so much time on medical claims that may result in denial, how can they improve revenue cycle management?

In addition, the little revenue they generate is not solely spent on them. But, a significant portion has to be added in the accounts of medical billing services.

Different Billing Rates for Different Medical Procedures

Another reason that researchers found out is that different types of healthcare visits cost differently. For Instance, a study report of an academic health system highlights the following data set for medical billing.

  • Primary healthcare visit costs about $20.49.
  • Inpatient stay costs about $124.26.
  • Emergency department visit costs about $61.54.

Based on these facts and the revenue associated with each type of visit, emergency department visit accounts for the highest billing cost, up to 25.2% of revenue.

On the contrary, inpatient stay cost the lowest as associated with the patient’s stay in the hospital.

Time Spent on Billing Services is Huge

With administrative cost, comes increased time consumption while processing medical claims. On an average, medical billing companies spend 13 minutes for primary care visit, 32 minutes for emergency department visit, and 73 minutes for a general inpatient stay.

The more time, medical billing services spend on analyzing medical claims, the more they charge physicians for their time.

Healthcare Industry Needs to Take Serious Actions!

Simple healthcare systems that have an easy reimbursement system can be a guiding light for the U.S healthcare industry.

Healthcare leaders propose that a single-payer healthcare system is a way forward towards the progressive route. However, only reducing administrative burden will not generate favorable results for revenue cycle management.

Healthcare quality should be the focus along with setting forth reasonable rates for the medical procedures. Moreover, the centralized processing of medical claims can also reduce healthcare expenditure.

Comment if you believe these reforms will somehow show a positive influence on the US healthcare system, or, do you think the opposite?

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4 Reasons to Outsource Credentialing by a Medical Billing Company

Medical billing companies save revenue cycle management for clinicians. Without the assistance of medical billing services, we doubt the efficient running of medical practice.

Healthcare industry is quite sensitive and responsible one. Physicians are supposed to practice their skills for the ideal health status of individuals. Especially in the on-going approach of the value-based healthcare system, physicians need to modernize their treatment methods now more than ever. Hereby, medical billing companies create medical bills and handle the billing tasks to get them reimbursements. Consequently, physicians can pay attention to their actual work.

However, in addition to the billing process, a professional medical billing company also offers credentialing services for clinicians, which is a vital part of revenue generation.

What is Credentialing?

It is a process, in which hospitals, insurance companies, or healthcare authorities verify and legitimize the educational background, expertise, and qualification of a clinician. Generally, this process takes place before including a physician in the working network.

Why is Credentialing Important?

When physicians are credentialed, they get timely and rightful reimbursements from the insurance companies.

Medical credentialing is not an easy process and requires extensive focus from the start of the process to the end.

No Immature can look into clinicians’ past and derive professional outcomes. The credentialing process is legal and can result in penalties if done unethically. Hence, this responsibility should only be given to medical billing companies.

What are the Challenges that Occur During This Process?

Credentialing Takes Time

Checking one’s background is a complex process. Therefore, it requires at least 60-90 days to fully credential a clinician.

Medical billing services when enlist a physician for credentialing, they are required to complete the whole process before he takes up a new patient. There is no room for error as the process involves the verification of sensitive fields such as employment history, education, medical training, licenses, and more.

Peers Don’t Cooperate

It is obvious that physicians are always tight on their schedule. Hence, there is little possibility that peers, who can give a vote of confidence for the physician will be able to respond to inquiries on time.

To avoid this delay in the credentialing process, physicians can inform their peers prior to the process. Moreover, they can also set a time to complete this task.

No Access to the Latest Information

Physicians need to have access to up-to-date information. However, medical practitioners are so busy in their lives that they remain oblivious of the latest information. For Example,

Clinicians working in the ambulatory surgical centers (ASCs) have to reevaluate their credentials after 1-3 years. When different clinicians have a different schedule for credentialing, it becomes hard for ASCs to manage all.

Thus, no access to the information at the right time creates issues for the credentialing service providers and the confirming authorities.

Inability to be Compliant with Value-Based Healthcare

Different states have different healthcare plans and so physicians are supposed to stay true to all the state exchange and federal healthcare plans.

Another challenge that a credentialing medical billing company faces is that physicians have to treat a reasonable number of patients to handle revenue cycle management. Moreover, medical practices should implement the right healthcare strategies. Otherwise, they’ll not be able to get reimbursements for the rendered services.

Considering the difficulty, medical practitioners choose to outsource for credentialing services. There is no way that unprofessional individuals should not take responsibility for this task. After all, physicians’ revenue generation is based upon it. Thus, only, a medical billing company as P3 Healthcare Solutions can outrun all the above-mentioned challenges for credentialing and insurance enrollment and offer an efficient solution.

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3 TRICKS BY MEDICAL BILLING SERVICES TO AVOID CLAIM DENIALS

Medical billing services constantly fight with the monster of denied medical claims. Denied claims top the list of factors that restrain efficient revenue cycle management. These have been a constant threat making the efforts of medical billers and coders to go in vain.

The claim rate has cost millions of dollars to the healthcare industry. Insurance companies reject hundreds of claims each year over minor issues. Not just big established medical billing companies do this mistake, but small practices also have a huge share in it.

Having said that, denied medical claims can be recovered with little care and organized follow-up services.

How to Accelerate RCM?

Hospitals and medical billing services can manage to increase revenue by eliminating all the reasons that cause denied claims.

Medical billing companies appeal for the denied claims, but it requires a lot of time and investment. It can also lag behind the rate of creating new medical claims.

How can medical billing services manage Denied Claims?

A simple solution is to recognize areas that are causing denied medical claims. Medical billing services can never optimize revenue cycle management unless they rectify those problems.

Given below are three easy ways to avoid denied medical claims.

Verify Insurance Benefits

One of the major reasons for denied medical claims is the problems in the patient’s benefits. Moreover, there are also some other reasons such as, deductibles, copayments, and secondary insurances that shake up the claim’s status.

To avoid all these issues, medical billing services need to verify the patients’ demographics along with the credentialing status of the physician. Also, checking all the information given by the insurance panel is mandatory.

Verify If Healthcare Provider is among the Insurance Network

Sometimes, the healthcare providers’ are not in the network of the insurance company. It can be a problem causing revenue leakage.

In addition, clinicians don’t know about the variance of the reimbursement rates in the insurance plan. There can be many factors that affect the variance.

For Example,

  • Location of the healthcare provider
  • Number of medical claims
  • Medical expertise

Medical billing services should check the insurance payers’ contract with the physician. These contracts specify under what rules and guidelines, the insurance company will pay. Coverage policies, referrals, pre-authorizations are also included in the contract, clearly stating the benefit plans to the patients.

The insurance payers’ contracts are legal documents but are negotiable. For maximizing the revenue cycle management, healthcare providers should efficiently explain their expertise to the insurance companies.

Keep Track of Accounts Receivable

A healthcare facility can’t run smoothly when they have pending accounts receivable. Keep track of the claims if they are paid or not. Follow-up services play a crucial role in revenue cycle management.

If a claim is not being paid within 60 days, medical billing services should directly get in touch with the insurance company. It helps in determining the status of the processed claim, or the claim will end up as a denied claim. Moreover, it also helps in reducing the rate of wear-out medical claims.

If the claim has been paid, record its date, if rejected, go for the appeal process.

The responsibility of medical billing services is huge. Denied medical claims disturb revenue management of not only physicians but also the medical billing companies. To decline the rate of medical claims denial, above-mentioned tricks reduce administrative errors. Consequently, investments and efforts are not wasted unnecessarily.

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