Medical practice has two major types of accounts receivable: reimbursement from insurers or government payers and the part of a charge that the patient is responsible for. Collecting payment from each of these two involves a completely different process, but a medical billing company will take care of both of them.
Medical revenue cycle management (RCM) refers to the entire financial cycle, from determining insurance coverage and patient responsibility, through billing payers and collecting unpaid fees from patients. Thanks to rising expenses and reductions in reimbursement amounts, it is more important than ever for practices and medical institutions to receive payment for every service delivered, and in order for a practice to be sustainable, it is necessary for payments to be collected as soon after the service is delivered as possible.
Medical codes are complex and constantly changing, so it is difficult for medical staff to keep up. External billing companies have become an indispensable resource for medical organizations, not only for filing and managing claims but for handling all aspects of RCM.
Here are five ways Medcare MSO can help in the area of accounts receivable.
1. Review of Previous Claims:
Most organizations have many unresolved, denied, and rejected claims. Even minute details, like a misspelled name or wrong date, will get a claim rejected, so when Medcare MSO begins to work on your RCM, we will review all the outstanding claims and get a resolution. Previous clients have been astounded at the amount of additional revenue we are able to get for them because we have billers who are experienced in each specialization, and they recognize the problems and get errors corrected.
Rejected and denied claims and the resulting delays in receiving payments puts unnecessary strain on the medical staff, doctors, clinical and hospital administrators. This can create a vicious cycle, wherein issues with claims cause stress for staff, so issues are ignored, but the lost income creates another kind of stress for the practice. Unresolved claims are no small matter.
The Medical Group Management Association (MGMA) has found that no attempt is even made to resolve 50-65% of denied claims. That represents a tremendous amount of lost revenue.
2. Billing and Coding Logs Upkeep:
Medcare MSO documents all claims, payments, denials and rejections, and claim resolution. We then study the results to find trends and determine how to avoid the problem in the future.
3. Monthly Billing Review:
Rather than just sending out a memo when an error is found, Medcare MSO holds monthly meetings that include all employees involved with accounts receivable, including everyone working on denial analysis, bill postings, documentation, CPT coding, and even data entry operators. By evaluating the service and providing ongoing training in this way, we maintain high levels of performance and operational quality.
4. Dedicated AR Teams for Accounts Receivable Recovery:
Keeping up with changes to medical billing codes, insurance plans, and government payer rules requires a dedicated staff who are able to focus on those things. In addition to commonly used codes, each specialization has a subset of unique codes for its practices, and some of these can be very complicated. In many cases, such as surgery, there are bundled charges, but if anything is done outside the expected pieces of the process, special coding is required.
The increasing complexity of medical billing has made it necessary for a busy medical practice to get help with billing and claims handling. Medcare MSO has dedicated teams for tracking and managing denied and rejected claims to ensure practitioners are fully reimbursed for services.
5. Collections from Patients
In most cases, when a patient receives medical care, he or she is responsible for paying part of the cost in addition to what the insurer covers. This amount should be made clear when the appointment is set to avoid upsetting patients later with unexpected charges. In many cases, a co-pay amount set by the insurer is collected prior to providing services.
There are other situations in which the patient pays a percentage of the overall cost, so the amount isn’t known until after treatment. There is also the possibility that the diagnosis results in tests or treatments that incur unanticipated costs, so it isn’t always possible for the patient to know all costs in advance.
A medical billing service makes sure the claim coding is correct, submits claims, and manages rejections and denials—and will also follow through with informing patients of their amount due and arrange payment. Assuring prompt and clear communication with patients keeps them satisfied that the bill is correct and also gets it paid.
Medcare MSO will improve your revenue cycle management and get the funds that are stuck in the insurance recovery pipeline delivered to you for a very small fee. Give us a call at 1-800-640-6409 or get a free demo today to see how we can help your bottom line!