We fondly remember the days, maybe not so long ago, when the revenue cycle was a much simpler system. You would collect the patient’s insurance information, treat them, submit the claim and get paid. But in these days of high-deductible health plans (HDHP’s) and ever increasing co-pays, more of the financial burden is steadily shifting to the patient. Now, take into account the shift from the fee-for-service to the value-based payment model – which private insurers are adopting at a fast rate – and the impact of the Affordable Care Act and you can see why getting paid has become a challenge.
The increasing popularity of high-deductible insurance policies, in particular, have forced some patients to put off paying their medical bills. Now it is not unheard of for a patient to owe a $5,000, or higher, deductible. According to a study by the Medical Group of Management Associations, a physician trade organization, bad debt in multispecialty practices rose 14% nationwide between 2008 and 2012. That is money that medical practices are owed but are unlikely to ever collect.
In response medical practices have had to start playing the part of creditors trying to collect a debt. Concerning deductibles and co-pays, the question healthcare receptionists ask patients has changed from “Would you like to pay that today?” to “How would you like to pay for that?” Medical practices need to watch their account receivables more closely and consider sending patients delinquent on payments to collection agencies more quickly. Many have taken the approach of asking for payment before any service is provided and maybe referring the patient elsewhere if it is obvious they will not be able to pay.
Avoiding claim denials is an important aspect of improving the efficiency of your revenue cycle. A denied claim can cost a medical practice many man hours to resolve. Insurance companies can and will deny claims for small data errors and discrepancies. Insuring that you are submitting clean claims that are free of errors can provide a large boost to your bottom line. Proper staff training and a bit of redundancy in your pre-submission claim check protocol can be a big help. Different insurance companies will deny claims for different reasons, so consider keeping a log that details your different payers’ nuances. What follows are some of the most common reasons that medical insurance claims are denied.
To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.