Tranquilmoney Reports: $125B in Rejected Insurance Claims Challenging Private Practices
Per Philip, there are two main reasons that doctors' offices don't always get properly reimbursed: (1) insufficient office staff that are adequately trained on how to complete the forms accurately, checking diagnostic codes, making sure everything is complete, etc.; and (2) the constantly changing landscape of rules and regulations governing what the insurance company and public payers will pay for.
When examining the issue of inadequate trained office staff further, one finds that up to 80% of medical bills contain errors.2 Insurance companies are very strict on correct medical billing and coding practices, so that the smallest mistake can result in a rejected claim. Kaiser Health Care estimated in 2010 that
Philip adds that the second thorn if a physician's side – the failure to stay up-to-date on medical billing regulations – is made more difficult due to constantly changing rules, requiring physicians and administrators to spend time and money on continuing education, software, or staff re-training to stay current, having a direct impact on the cash flow and profit of the practice.
Compounding the issue, there is a zero-tolerance policy by Medicare and Medicaid for errors and suspected fraud, so that practices may be prevented from billing Medicare or Medicaid services for years.
The risks are not just financial; failure to bill correctly can impact a patient's treatment due to an incorrect diagnostic code.4
Industry experts estimate that 25-30% of all healthcare claims are denied or rejected. 5 Practices do their best to keep their billing rejections below 5% if possible. Time spent attempting to manage claims denials just delays timely reimbursement even further – especially as most providers use manual processes. But this is avoidable – if the doctor has the technology tools to manage income from insurance companies, medical coding and regulations.
Doing so will gives physicians access to a staff of experienced coding and billing professionals and a range of other services that can help their business reduce costs and increase revenue. Medical practices and health care organizations often find they save time, money, and resources when they use an experienced medical billing company, making it well worth the funds spent.6
Specific technology tools from
1 "Medical Billing." Hospital Billing Errors | Medical Billing Services, Healthcare Business & Technology,
2 Loria, Keith. "Easy Tips for Physicians to Reduce Billing Errors." Medical Economics,
3 "Medical Billing Errors Create Significant Costs For Patients."
4 Medical Reimbursement Services. "How Medical Billing Mistakes Can Hurt Your Practice." Medical Reimbursement Services,
5 "Avoiding Denials: 5 Ways to Improve Claims Reimbursement." Rev-Ignition,
6 "How Medical Coding Mistakes Affect Your Revenue?" Latest Updates on Medical Billing - MedicalBillersandCoders.com,
Read the full story at http://www.prweb.com/releases/2018/05/prweb15479372.htm
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