In today's economy, outsourcing medical billing is a question many physicians ask themselves. However, the real question should be: "Can you afford not to outsource your medical billing in today's economy?" Having worked in a medical office for many years and doing medical billing in that office, I have seen firsthand the lack of attention and dedication placed on the medical billing department. Many times in a busy medical office, the job of doing the billing may be placed on someone who has extra time on their hands or has "downtime" from their regular duties. If the physician does have an actual billing department with staff dedicated to billing, many times they do not work as efficiently as they should because there is no motivation to do this. This is not only irresponsible on the physician's part, but it is costing their practice thousands of dollars each year due to untimely filing and inexperienced staff. Now more than ever, insurance carriers are decreasing reimbursements while increasing administrative burdens and costs. Staff needs to be knowledgeable in billing and coding as well as have access to updates provided by the insurance carriers on policy changes and reimbursement changes on a daily basis. This is why outsourcing is the answer to a difficult question. Most medical billing companies today bill providers on a percentage of receipts collected, which directly ties the success of the billing company to the success of the physician's office. It creates an immediate incentive to work together for the same goal, which is maximum reimbursement of charges submitted. Additionally, accepting credit and debit cards as a form of payment is much more convenient for the patient and much more efficient for the office. If you have an efficient and knowledgeable billing company, they will provide front staff training as part of their services so that both the front staff and the billing company work as a team in unison to maximize reimbursement for the office. Since this is the ultimate goal of any physician's office, the question should be: How can you afford not to outsource to a qualified, efficient, knowledgeable billing company?
It is generally accepted that the method of payment to physicians affect their professional attitude and behaviour. Consequently, health policy makers manipulate payment system in an attempt to achieve optimal health care for their citizens such as improve accessibility, quality of care, patient’s satisfaction and cost containment. In Ontario, there are a wide range of mechanisms that are used to pay physicians for their services that are funded by both federal and provincial government. According to Canada Health Act annual report (2013), the majority of primary healthcare physicians are funded using the fee for service payment arrangement but of that majority, only less than 30% are compensated exclusively according the fee for service plan. The remaining physicians are funded using one of the following mixed compensation models:
Those patients who have health insurance are expected to pay their co-payment immediately upon checking in. You are required to have an insurance card and know your co-payment ahead of time. Typically speaking, co-payments for urgent care range between $35 and $100 per visit. You will have to check to make sure your insurance is accepted at your local urgent care center.
Medical billing transforms health care services into billing claims. The responsibility of the biller is to follow that claim to ensure the physicians, hospitals, third party billing companies, as well as federal and state governments receive reimbursement for the work that is provided. An experienced biller can boost revenue performance for the facility while keeping the business running smoothly.
In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
Healthcare payers agree with the idea of Evidence-Based Medicine (EBM) to advocate for pay-for-performance in provider reimbursement on quality and efficiency. The fundamental system that most payers use to compensate physicians and provider associations embodies enticements for excellence and efficiency. Reimbursement can be affected by the P4P approach and other factors such as the claims process, out-of-network payments, legislation, audits and denials. While the same P4P approaches are attempts to commence incentives and new strategies into the healthcare, the underlying arrangement of the compensation system produces many per...
Since the quality of healthcare would not suffer, the only thing to lose through maximizing efficiency is a bunch of waste. Through its administrative simplification advocacy, the American Medical Association (AMA) claims that up to 14% of a physician’s revenue is taken up by administrative waste. The goal of the administrative simplification is to inspire physician practices to use computerized, instantaneous health plan transactions, minimize manual procedures through the claims revenue cycle, while increasing transparency and reducing vagueness with the payment process involving the insurance company. It is the AMA’s hope to push this movement into high gear, getting more practices on board and to eventually see a decline in wasteful and inefficient administrative
By examining the cost effectiveness of physician assistants compared to Physicians potential healthcare employers may be able to make better economic decisions by the staffing of mid level providers versus traditional physicians. Because four physician assistants can be staffed per physician one can see the potential savings from an employer’s perspective, taking into consideration the growing workload and demand for mid level providers (Halter, 2013).
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
The healthcare industry has already begun the transition from a fee-for-service model to a pay-for-service model. This migration will continue as efforts are made to decrease the cost of care while improving patient
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
Thresholds were originally set at account balances of a 3:1 ratio for larger versus smaller clients. Facilities with larger revenue were considered below threshold if the patient’s total account balance was 3 times that of the facilities generating smaller revenues. As a result of this process ratios have remained consistent at 3:1 but overall balance thresholds were reduced. This meant that original balance thresholds were $3000 and $1000, but were reduced to $1500 and $500 due to more efficient uncollectable accounts receivable
In recent times, healthcare organization across the nation are facing unprecedented challenges as they strive to improve the overall quality of care provided to their patient’s population, while improving their organization’s financial performance. Furthermore, uncertainty of new reimbursement models, diminishing reimbursement, and complicated compliance regulations are playing the role of a catalyst for streamlining the Chargemaster process in majority of healthcare organizations.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
One may argue that through each day we take part in negotiations. “Negotiation is a dialogue between two or more people or parties intended to reach a beneficial outcome”(Wikipedia). In healthcare, we all have a common goal to provide exceptional quality care to our patients. There may be an imbalance between payer and provider. It is important to identify this imbalance and successfully prepare to negotiate or renegotiate these contracts. The cost of healthcare has gain a major focus of attention with legislature and policy reform. Healthcare in general, has had a huge impact on the U.S. economy. In today’s health care delivery system, contracts are negotiated between the following agencies: insurances, physicians, institutional providers,
A hospital billing process begins when an individual comes in for diagnosis and treatment for an injury and is admitted for more than 24hours. The admitting clerk first obtains a person’s demographic such as age, gender, address, symptoms, and insurance information which is entered into a computer system. Once everything is verified by insurance verifier, admitting clerk collects co-payment and assign a patient an account number, which is associated with all charges and payment related to the duties of care. Once a patient is admitted the attending physician dictates history, which includes admitting diagnosis. Then the nurse enters the patient’s medical records and inputs physician orders in a computer. After attending physician supply documentation