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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?

Share your thoughts at https://www.linkedin.com/company/p3-healthcare-solutions

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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