One of the biggest challenges faced by healthcare practices and crucial to their very survival is medical billing and collections. A healthy revenue cycle is important to sustain the process of making patients healthy. Unfortunately, physicians are trained to manage human health rather than revenue health and this is where the challenges arise.
Billing patients for outstanding balances after receiving the portion covered by the insurance company is known as balance billing. This can happen if the insurance company gives less than the amount expected or if an episode of care is mistakenly believed to be in-network and hence expected to be covered by the insurance company. Physicians who are not bound by the in-network rate agreements and are thus classified as out-of-network physicians,
Medicare enrollment can be very confusing for those enrolling for the first time. From being aware of the enrollment period to understanding the type of health coverage required; from finding out the various options available to being knowledgeable of the various scams related to Medicare – all this can cause stress and confusion. Choosing the right plan requires an individual assessment.
An ongoing challenge for all hospitals, revenue cycle management requires the use of technology to keep track of claims and address issues as and when they arise. It is fairly common for claims to be denied, denial management being an industry wide challenge. Efforts by healthcare facilities have not made much impact in the reduction of claim denials.
Medical billing is an important part of your practice. In fact, it is one of the crucial aspects, which if ignored or not handled properly, can even lead to the practice eventually facing closure. Healthcare providers handle their medical billing either in-house or through outsourcing. However, the benefits of outsourcing your medical billing are far more than keeping them in-house.
Medical practices have been leaking money for some time now – increasing expenses, shrinking insurance reimbursements, and increased compliance parameters means more paperwork than ‘actual’ work. Relying on practice managers to help cut down your expenses could prove tricky if not done right, then there are efficiency and technology challenges that have been plaguing a number of practices.
Revenue cycle is defined by the Healthcare Financial Management Association as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” The term includes the entire tenure of a patient account – from its creation to the payment. The process of revenue cycle flows into and affects each component of the system.
The Healthcare Industry has always been on top of the game when it comes to technological advancements and usage. Computers, ECG machines, even artificial intelligence has been integrated with leading US hospitals. However, most of these advancements have been in the core medical practices.
It is universally known that American Healthcare has one of the most complex billing systems.
University of Pittsburgh Medical Center (UPMC) reported $212 million in bad debts for the fiscal year 2014. The numbers are not deniable – the reason for bad debt is higher deductibles. While choosing their medical insurance plan, most people tend to choose the plan with the least annual premium, what they fail to realize is lower premium means higher deductible.