The physicians are trained personnel who can administer all the medications and treatments to make sure a person is completely recovered. However, most of the challenges physicians face are related to billing or preparing claims. However, each and every clinic in the US face cash flow issues, and reimbursement cuts increase the overhead cost. The clinics see the problem in contract changes, payment delays, and high-deductible costs. These billing errors can significantly affect the clinic’s revenue process. The clinics move quickly from one patient encounter to the next. The outsourced physician billing teams push the heavy claim volumes with the right codes.
Why Revenue Leak Gets Unnoticed
The healthcare staff performs several tasks inside the clinic. In one hand, they tackle all the clinical duties and on the other hand, they look after all the administrative hassles. Hence, they miss out on small details which cause claim denials.
1) Relying on Surface Metrics
Most of the payers mostly track total charges, collections, accounts receivables and adjustments. These reports don’t cover the whole story as they show mostly the issues inside the billing performances. Hence, these surface metrics don’t reveal everything which can cause issues.
2) Lack of Real-time Revenue Cycle Visibility
Accuracy and transparency are essential factors of the reporting dashboard. These dashboards show all the KPIs including the denial and clean claim rate. The net rate of collection and accounts receivable days helps the clinics to make better decisions. Most of the physicians offices operate with outdated systems, and the old billing software is used to create a full workflow. Hence, the clinics face authorization slowdown, new denial cluster, and coding inconsistency. So, when the errors come into the picture, the financial damage is already done.
3) Overworked Internal Billing Teams
The billing staff work with the fullest capacity as they process all the claims along with patient care. They also ensure proper documentation and coding to create accurate claims. These in-house teams are responsible for:
- Fixing all the patient eligibility issues
- Managing claim denials
- Responding to the internal queries
When the workload increases because of unexpected patient volume, they do not scale up. They get the claims out, move things and hope nothing major happens.
4) Complex Payer Rules
Each and every payer revises guidelines at their own pace and medical necessity updates, bundling edits, CPT interpretations and prior authorization need shifts without major notice. The internal teams need to learn about these changes which divert their attention from patient care.
Major Revenue Leaks in Physician Billing
A small mistake in the patient’s eligibility verification, documentation, coding create payer denials. Moreover, the changing healthcare regulations as well as payer policies also create revenue leakages.
1) Incomplete Charge Capture
All the missed charge captures occur more than expected, and it leads to claim denials significantly. A clinic doesn’t document procedures, and the performed services don’t get recorded. Always remember that a rushed patient entry can create hassles, and these omissions lead to lost clinic revenue.
2) Over Coding and Under Coding Issues
Under coding leads to getting lower payment than the actually provided service, and over coding leads to getting higher payment for the rendered service. These issues create documentation gaps and confusion about payer interpretations. It happens because of a lack of inconsistent staff training.
3) Prior Authorization Denials and Delays
Prior authorization is an important step in revenue cycle management. It doesn’t help the payers with controlling cost, but it also makes sure to get the insurance coverages for all the prescribed medications and treatments. Most of the prior authorization requests the payer deny because of lack of medical necessities, documentation gaps or coding errors.
4) High Rate of First Pass Claim Denial
A high rate of denial invites trouble through errors, outdated payer rules, missing details, or incomplete documentation process. Most of the groups underestimate the cost of denials as they don’t look at the numbers; they look at the left behind money.
5) Not Following Up
Aged claims mostly die in the backlogs and as the internal staff performs several responsibilities, they miss out of the unpaid claim follow-up. So, payers don't pay which becomes a major cash flow issue.
Reasons You Need Outsourced Physician Billing Experts
The physician billing outsourcing company have dedicated experts who stay updated with all the latest codes to make sure no claim denial occurs. Moreover, they can also reduce your operational costs by 80% and work with 10% buffer resources to make sure no claim denial occurs. These third-party experts provide dedicated account managers, and surprisingly, these companies don’t have any restrictive clauses or binding contracts. So, if you want to streamline your billing process, it can be a feasible option to outsource physician billing services in that matter. Hence, take the step today and see the difference they can make to your clinic.