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Are patients with high deductibles a threat to medical practices?

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It is time for medical practices to focus on patient collections!

Does high deductible mean low chances of getting paid?

Patient responsibilities have risen under the latest healthcare reforms. Coming forward, most patients would pay most of their healthcare bills by themselves. With payment responsibilities shifting to patients, managing patients with high deductibles is a risky proposition for medical practices.

High deductible insurance plans are the order of the day and physicians, who fail understand this emerging trend, will find themselves in an unenviable position. By the end of this year, an estimated 20 million patients will join the healthcare system and an alarming 80% of the newly insured patients, are at high risk for non-payment.

In a perfect world!

Higher out-of-pocket expenses are going to leave physicians with the unsavoury task of making patients pay their bills. In a fair world, patients would pay prior to treatment and coordinate with the doctor’s office regarding payment options. Patients would be well informed about insurance plans and guidelines.

But the healthcare world is anything but perfect. Everyday physicians face irate patients, lawsuits and threats to move to another provider.

Sounding harried over the phone?

The average time medical practice staff spend over the phone has increased and a call can last anywhere between 10 to 40 minutes. Blame it on complicated health plans and insurers who change payment regulations, constantly. Most private practices are understaffed and find it difficult to handle the deluge of patient calls.

Patient portals have been of tremendous help, but again, patients need constant support and education to access and use patient portals. Which leaves medical practices with one question- who does the tough job of receiving payment from patients?

Handling patient payment is a tough nut to crack!

Receiving patient payment isn’t just about sending sporadic statements, now and then. It requires close coordination with patients prior to a visit. Educating patients and helping them discover plans and payment options that best suit their needs, is essential. As is, following up with patients and sending out patient statements regularly.

And, always, ensuring, that patients don’t feel like, they are being cornered. Medical practices, now, rely mostly on collection agencies to handle their patient billing process. It avoids bad blood between patients and the medical practice. Trained professionals do a much better job and can free up in-house staff to focus on clinical activities.

Medical Billing Strategies of 2014 – Sink-in to Amplify Your Funds

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Medical Billing Process

Decide Here – Whether to Dwell-in or Leave the Page!

This article is especially designed to meet the needs of the physician practices and other healthcare delivery organizations that are looking for the tactics to revamp their medical billing process so as to boost your cash inflow.

 Where the healthcare billing is travelling?

Though, physicians aren’t tethered to the aged technology and strategy, circumambient healthcare milieu may revoke your cerebral cortex due to diversified growth in healthcare information technology (HIT).

Do you have numerous “wh-questions” on your mind – pertinent to the funds management in your revenue cycle management (RCM) process? Then, this is the go-to technique to enliven your cash coffer.

MEDICAL BILLING STRATEGIES – 2014

Hoard your revenue in each phase of RCM!

Physician Credentialing and Contract Negotiation:

The federal payers have already fixed your reimbursement rates for the patient care services. Despite this, there is a dire need for the providers to negotiate with the payers to get lucrative reimbursements for the service rendered by you. Besides, abiding the payers’ rules during credentialing process brings you more savings.

Front-desk Collection:

Start collecting payments from the scratch – don’t let your staffs ignore the front-end tasks:

1. Point-of-service (POS) payments (Co-pays, deductibles, etc.).

2. Collection of dues well before patient encounter.

3. Thwarting denials through accurate eligibility verification.

4. Gathering insurance accurate data to avoid reimbursement disappointments.

Charge Capture:

HITECH Act, ACA’s “performance based payment” and other federal mandate are the driving forces that accentuate the ideal EHR implementation.

Charge capture must be done accurately for each encounter, procedure and surgery. Evolving ICD-10 guidelines call for the renovation of your super bills in sync with your clinical practice so that charge capture will be immaculate.

Claim Scrubbing:

          This is the vital phase in the medical billing process that aid abridged AR process. AAPC/AHIMA certified coders must be a part and parcel of the claim scrubbing process – so that revenue loss due to underpayment and overpayment issues could be avoided. Concentrating on this phase greatly mitigates the claim rework cost.

Electronic Transmission:

          Timed Clearinghouse transmission for fresh claims is one of the overlooked approaches in most practices. Large practices may need to file the scrubbed, “clean” claims daily.

          Delay in addressing the rejected/denied claims with the remedial action may also hamper your cash in-flow.

eRemittance:

          Interpretation of the remark codes and timely payment posting after the receipt of EOBs/ERAs is very essential for a successful RCM process. Besides, prompt cash inflow/ AR feed into the practice management system (PMS) or electronic medical/ health records (EMR/EHR) is mandatory to avert payment miss-outs and pointless follow-ups.

Denial Follow-up:

The denials must be addressed with an immediate effect to avoid delayed payments or re-denials. While working out on denials, the obligatory documents must be attached during re-submission or appeal. Though the cost involved in denial appeals or re-submissions is an additional burden, ignorance of denial management would be a serious pecuniary loss.

Patient Billing:

          Don’t load your dice against yourself! Precision in the patient billing is a crucial point in the bill settlement. Inaccurate and difficult-to-read billing statements ensue in patient discontent, consequently culminating in bulldozed physician – patient relationship. Above all, a clear statement supports timely payment.

Resource Utilization:

          Exploiting the resources like human resources, infrastructure, funds, technology, etc. to run a practice profitably is a master skill. Among that, leveraging the technology to satisfy patients and enhance practice profits is the challenging task. The following technology platforms ameliorate your patient experience, accelerate revenue cycle process and thus perk-up your business.

Practice Website:

  1.  Patient portal
  2.  Online forms and statements
  3.  Online EHR access
  4.  Online lab and imaging reports
  5.  e-Payment support
  6.  mHealth support (iPad, iPhone, Tablet, etc.)
  7.  Chat support
  8.  Healthcare News
  9.  FAQs
  10.  Social media (e.g. Facebook, twitter, etc.)
  11.  Patient Blogs & forums

Benchmarking:

                  Setting a yardstick and working towards its accomplishment must be the prime goal, if you are attempting to reach your vision and mission.

What functions of the billing process that must be set in the yardstick achievement program?

1. Follow-up and retrieval of underpayments.

2. Averting penalties due to the breach of laws and audit policies (RACs, HIPAA, HITECH Act, etc.).

3. Aggressive follow-up of accounts receivables/bad-debts.

4. Evaluating and making small balance write-offs.

Besides, regular evaluation of your practice, process and finance must be done through the following reports:

  1. Practice Analysis Report
  2. RCM Analysis Report
  3. AR Summary Report

“PERSISTENT REVENUE INFLOW IS THE SINGLE PARAMOUNT WANT OF THE MEDICAL BILLING PROCESS”

Stretch your achievement from good to excellent with these proven medical billing strategies. It will be the hot topic in 2014 as most practices are going out-of-kilter due to stringent policies and other industrial factors.