Challenges in Medical Billing Industry

Do you know the reason that why Healthcare Providers face challenges with Medical Billing?

Here are some important reasons;

TIME CONSTRAINTS:

Day-to-day business operations at a practitioner's site represent a bustling and eventful array of healthcare services. But most medical offices are very limited on administrative time as their primary focus is healthcare operations. As such, a conversion to a new system will require a significant effort and expense for the practice, a move that they are reluctant to make.

BUDGET CONSTRAINTS:

As with any successful business, one of the keys is to keep overhead costs to a minimum and to extend the useful life of all capital assets. To process claims electronically, the practice will need to acquire additional software, perhaps additional hardware, and spend a large dollar amount for training on the conversion.

On-going costs are also high. Due to the high employee turnover in medical clinics, doctors constantly hire and train new staff. Maintaining a computer system means paying for constant annual upgrades, training and support contracts.

STRICT PROCESSING GUIDELINES:

Healthcare providers are required to adhere to strict processing guidelines established by insurance companies and government agencies. Failure to comply with these strict guidelines results in claims being rejected, which in turn has an adverse effect on cash flow. Healthcare providers seldom are willing to take this chance. Additionally, when they process claims, they are required to batch claims which may result in a delay in processing, thus forfeiting one of the key benefits of electronic claims processing.

LIMITED EXPOSURE TO THE BENEFITS OF ECP:

Most healthcare providers are familiar with electronic claims processing but are unsure how the process may impact them specifically. With limited exposure, they do not have the ability to recognize the tremendous potential in cost savings, efficiency and improved cash flow that electronic claims processing can provide.

MOST DOCTORS ARE NOT TRAINED FOR BUSINESS:

Healthcare providers spend 10-15 years in medical studies. Even while they are practicing medicine, they have to stay active in medical research and development. Most doctors are not experienced in running a business. They rely heavily on professionals to take care of their business.

Why Outside Billing is Better?

Outsourcing the medical billing function enables physicians to focus on the critical care of their patients. With ever-changing insurance rules and HIPAA regulations, healthcare reimbursement and processing medical claims are too complex to maintain in-house. By outsourcing the medical billing process, physicians are able to "wash their hands" of all administrative details involved in handling relations with insurance companies and government agencies. Medical professionals can then concentrate fully on what they went to school for and what makes them money: treating patients and practicing medicine ­­ because when medical billing falls behind, payment is being held-up. For example, you see a tax accountant to do your taxes (why because he/she is the expert, the same theory holds true when deciding whether to outsource medical billing or do it in house.

While in-house billing provides the perception of control, it actually increases the risks of losing business-critical knowledge, raises concerns about data security, impedes accuracy in claims processing, and ultimately limits billing transparency. Also, it doesn’t matter to an in house medical biller how much he/she collects, they are going to get paid regards of what they collect. However, outsourcing works on incentive basis, it’s their job to collect as much money as they can for a practice.

 Many healthcare providers have outsourced their medical billing as a tactical approach to have their medical billing completed professionally and efficiently. Outsourcing the reimbursement cycle to HEALTH INFORMATRIX allows physicians to save time and money because every minute that a physician or employee spends on an activity that does not directly add value to the patient's well being, is a cost that can be saved.

When used as a long-term strategic management tool, physicians can reap many rewards from outsourcing the medical billing function.

Access Specialized Expertise and Resources

Using HEALTH INFORMATRIX provides access to specialized medical billing tools, techniques, technologies, and knowledge that can only be maintained by a company that has focused its learning and business on providing top rate medical billing services.

Reduce and Control Operating Costs

The single most important tactical reason for outsourcing the medical billing function is to reduce and control operating costs. Achieving greater economies of scale and advantages based on specialization, is clearly and simply one of the most compelling tactical reasons for outsourcing.

Improve Cash Flow & Promptness of Billing

Eliminate cash flow interruptions that occur when in-house medical biller leaves or goes on vacation. Developing a steady cash flow will only enhance the practice's bottom line.

Free Resources for Other Purposes

Redirect the medical practice´s resources from non-core activities towards activities that have the greater return in providing medical services to patients. By outsourcing a non-core function such as medical billing, staff´s energy is free to focus on greater value-adding activities for the practice.

Share Risks

Government regulations (HIPAA), the marketplace, competition, financial conditions, and technologies all change extremely quickly. Keeping up with these changes, (technology and know-how) is an expensive and time-consuming endeavor.

 If you are like most medical providers, you probably never had the time to work out the comparison of outsourcing your billing vs. doing it in-house. Below is a quick analysis of potential savings by outsourcing your billing needs:

In-House Base Pay: $14.50/hour Yearly: $30,000.00 Medicare & Social Security: $2295.00 Retirement: $1040.00 Disability:$720.00 Health Care: $5220.00 Vacation/Sick: $3270.00 Annual Collections: $470,000.00 Annual Total  1 In-House Biller: $42,585.00	Medical Billing By HEALTH INFORMATRIX Medical Billing at: 5% of collections Annual Collections: $470,000.00 Total Annually: $23,500.00 Savings: $19,085.00
*Does not include: Software Paper/Envelopes/Stamps Clearinghouse Fees Reference Materials	Medical Billing at 5% of collections  Annual Collections $470,000.00 Total Annually: $23,500.00

CONTACT US AT:  healthinformatrix@gmail.com

Our best endorsement for our services is your testimonial.  The greatest honor to our business is your referral.

Some facts about Optometry Billing

Opthalmology/Optometry Billing

(Research Report)

Some Facts:

1. 3^rd Largest Independent Professional in US Healthcare.


2. Different from Normal Billing Services.


3. Separate billing staff required which should not be involved in normal billing.


4. Coding & Billing guidelines change.


5. Insurance guidelines change.


6. Medicare has different guidelines.


7. Easy practice than normal billing.


8. Mostly done In-House, small amount of billing services are doing in India.


9. Claims easy to process.


10. Limited use of modifiers.


11. Tough Insurance guidelines.


12. Different service plans. (VSP – Vision Service Plan etc.)

 Questions:

1. Total Number of Providers?


2. Total collected amount per year?


3. What are the main insurances covered under the practice?


4. Is there any given fee structures or we should follow medicare fee structure?


5. Do you use Local Codes (National Codes: eg 0187T) or only standard codes i.e. CPT Codes?


6. What are the Eye Services provided in the Practice? (eg: Laser Procedures, Keratoplasty, iridotomy, intraocular Lenses etc) 

 Services:

1.      Virtual Front Desk

a.      Appointment Scheduling

b.      Online Eligibility Verification

2.      Medical Billing Services

a.      Medical Coding

b.      Medical Billing

c.       Charge Capturing

d.      Claims Submission

3.      Payment Posting

a.      Payment Posting

b.      Review payments

c.       Follow-ups

d.      A/R Receivables

4.      Denial Management Services (If needed seperately can charge minimum 20% and maximum 30% depends on volume)

a.      Insurance Follow-ups

b.      Patient Follow-ups (If instructed by the provider)

c.       Appeals

d.      Aging billing

5.      Provider Credentialing/Re-Credentialing

Competitive Pricing Structures:

There are many companies providing the services in different way.

·        %age on total collectable amount.

o   In-house billing charge minimum 10%, in India rates are vary but these services mostly be done in In-house billing.

Per Transaction Models

·        Model 1

o   Less start-up fees.

o   Low price per month per provider.

o   $2-/+ per claim

o   Service include only filing of claims to the insurances.

§  Medical Coding

§  Medical Billing

§  Claims Submission

·        Model 2

o   Less start-up fees.

o   $175 per month per provider.

o   $2.50 per primary claim submission

o   $1.50 per secondary claim submission

o   Services Include

§  Providing Fee schedules updates insurance to insurance.

§  Medical Billing

§  Collections

§  Denial Management Services

§  Appealing Problem Claims

§  A/R Services

§  Monthly reporting system

Leave your comments for more information with your email or directly email at help@healthinformatrix.com

 

Thank you for your time.