There is a never ending revenue cycle war between the healthcare providers and the insurance companies that do not want to pay them what they deserve. Yet, there is this industry of experienced professionals out there, an army if you will; standing on the frontline armed and ready to win this battle.
This untapped resource of revenue cycle managers; reimbursement specialists; practice management specialists; most of whom have a passion and a desire to close this widening gap between provider services rendered and physician reimbursement for services rendered.
The science of medical billing and reimbursement is becoming more complex. It takes continuous research and education to stay abreast of all insurance changes, rules and regulation, including changes in coding, such as the impending ICD-10.
Professional medical billing companies offer healthcare professionals and facilities a cost effective means of revenue cycle management. Offsite practice management specialists and medical billing companies have the ability to place total focus on the practice accounts receivables and the total claim cycle from eligibility and benefits to the insurance payments posted to the physician account.
The right team of professionals will go above and beyond the standard measure of simply filing a claim to analytically enhance practice revenue and performance.
Truth Be Told…
With the economy as it stands, and even in the best of times, most physicians still find themselves operating in the red, unable to pay themselves and just barely able to pay their staff. Some are finding themselves taking out a second or third mortgage just to keep their businesses up and running.
And the culprit at the center of this crisis…office operating expenses. Research has been conducted, surveys been done and the results are almost always the same. Overhead cost is the number one financial challenge to small and large practices. Most physicians and physician groups just do not have the resources to employ 3 to 5 people in their office to do the amount of work that absolutely has to be conducted on a daily basis to keep the physicians revenue where it should be, much less to enhance revenue. A tragic truth is that, more often than not, physicians are unknowingly losing thousands year after year because of the lack of follow up on denied claims and in some cases, claims that have not been filed at all. For a successful practice, every measure must be taken to collect on each and every claim.
Some physicians have given in to the idea of closing their business; others have considered selling out to large hospital groups. Most physicians do not want to do either. When a private practice becomes a part of a hospital group, the hospital can then negotiate or even demand higher rates from the insurance companies; in turn insurance companies raise insurance premiums on the patients. So this option impedes on the physicians independence in running their own business and also negatively affects the patient as well…a no win for both patient and provider.
Out With the Old…
There seems to be a stigma around outsourcing medical billing as if in-house billing is the way it should be done because that’s the way it’s always been done.
As technology advances, and as the revenue cycle and billing process become more complex, healthcare professionals are realizing this traditional way of thinking is suffocating practice performance and growth potential. For years hospitals and other facilities have found it more efficient to outsource all or part of their billing processes, whether it’s current patient account collection or collecting on aging accounts receivables.
No one can tell you whether outsourcing is right for your practice; you as a healthcare professional can best make the call.
Measure your practice performance to determine your needs. If you have low revenue performance and your costs are high, then you may want to consider hiring outsource professionals. However, if your performance and costs are at an even point, then a few adjustments in your in-house billing staff may raise your performance.
Keep Your Hands On the Pulse…
The pulse of every medical practice is revenue and you as the healthcare professional should remain in control of every detail when it comes to your practice.
In choosing the right medical billing/practice management company, make sure they offer more than just filing claims alone. A great practice management company will work with you to assess the needs of your practice. They should offer a dashboard to their system or have the ability to sign into your current system giving you the ability to track and monitor their performance.
They will go beyond standard measures to:
analytically track critically important billing and reimbursement problems
analyze and rank your CPT codes to ensure you are billing for absolutely everything you do (including extra time spent documenting) to ensure the highest reimbursement possible
ensure proper use of modifiers
Transparency and communication is a key factor to remaining in control of your practice.
Meshon Tucker has over 15 years of practice management experience. Armed with a degree in healthcare administration with concentration in finance, she began her career in medical reimbursement in Santa Ana, California and has worked in a number of healthcare settings including hospitals, physician’s offices, long-term care and skilled nursing facilities gaining extensive knowledge of these specialties.
Tucker is the founder of Merit Medical Billing Associates and can be reached at