Are medical claims reimbursements getting more challenging for your practice? You are not alone. There are other practices that have suffered the same in past years, and are still struggling with this problem.
"83 percent of Physician Practices with under five practitioners said the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81 percent)."
Here are some tips and recommendations on how to avoid this problem and improve your medical reimbursements.
1. Get to Know More About Your Patients’ Health Plans
Not all health plans are the same.
Your patients may be presenting you an ID card with the same logo or from the same healthcare provider, but it doesn't necessarily imply they share the same health plan. Plans may vary regarding:
- Filing requirements
- Rates
- Benefits
Thus, it is important for the front desk staff to familiarize themselves with each patient's plan.
How is this possible?
Ensure your current office staff are kept updated regarding the various plans provided by your payers. Or, hire the services of a highly knowledgeable medical billing company familiar with the varying coverage and benefit mandates of healthcare providers.
2. Understand Your Market
You will most likely coordinate with three or more insurance companies each year. Thus, it is best to develop a strong foundational knowledge of their industry practices and trends. This includes the following:
Identifying the major payers of your practice
Prepare a record of your prevalent employers, unions, and providers that work with your practice. Compile the plans, networks, and payers of these patients. Familiarize yourself with these to manage their accounts efficiently.
Learn more about your managed care contracts
You may have provided several discounts to certain payers because of the number of patients they have endorsed to your organization. However, be cautious of how these discounts will impact your revenue.
Are these discounts providing enough revenue to your practice? If not, data can show you how much revenue these payers are adding to your practice. This will give you leverage when negotiating discounts with these payers.
Never fail to verify
This may sound elementary, but verifying your patients’ benefits, plan requirements, and eligibility is very important to any practice.
Conduct due diligence. Invest in a system that allows you to easily track and monitor the medical claim reimbursement efficiency of these payers. In doing so, you will know who among these payers are making medical reimbursements more difficult.
3. Be knowledgeable about the current trends associated with your practice
Medical practices vary depending on specialization. This makes it important for your practice to remain updated concerning the different trends happening in your practice.
This includes:
Bundled Payments
It is relatively common for some payers to combine the rates of facility and professional reimbursement, radiology, lab, and anesthesia into one payment scheme. Your medical billing team should be aware of how these should be handled.
Price Transparency
As more patients are demanding enhanced transparency on medical fees, practices are under added pressure regarding how their medical service fees are to be quoted. Know the various billing laws related to this matter to avoid encountering patient conflicts.
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About ClaimCare
ClaimCare is composed of an incredible team of professionals, including: certified coders, practice managers, medical providers, credentialing experts, and experienced business professionals. We aim to make your medical billing more effective and efficient. Call us at (855) 376-7631 if you need help with any of your medical billing needs.