Why Are You Losing Money with ‘Insurance Only’ Billing?

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Why Are You Losing Money with Insurance Only
Billing?
What is Insurance Only Billing? As the name
suggests, in Insurance Only billing, healthcare
practices accept the amount the insurance company
will pay and waive patient responsibility
portions like co-pay, coinsurance, and deductible
amounts. In most circumstances, this puts the
physicians and the practices in jeopardy,
especially when your client base is Medicare
patients. Medicare pays providers the lesser of
the reasonable costs or the customary charges for
services furnished to Medicare beneficiaries.
Practices that routinely waive co-payments and
deductibles have been charged with violating
Anti-kickback Statute (AKS). The AKS is a
criminal statute that prohibits actions intended
to induce or reward referrals for items or
services reimbursed by federal healthcare
programs. Consequently, discounts or write-offs
should never be given to encourage patients to
come to a practice. Commercial payers may
prohibit waiving or discounting cost-sharing
amounts such as co-pays, coinsurance, or
deductibles. In certain states, routine waivers
of co-pays and deductibles may be considered
insurance fraud and may subject practice to
criminal liability. In some states, routine
waivers of co-pays and deductibles as a
professional courtesy are considered insurance
fraud. Routine waivers of co-pays and deductibles
and professional courtesy discounts for the
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Why Are You Losing Money with Insurance Only
Billing?
commercial insurance beneficiaries also can be
considered a violation of the AKS if the
recipient or a family member is in a position to
refer federal health program beneficiaries to the
physician or practice. Practices that wish to
continue offering professional courtesy discounts
should consult a billing expert to evaluate
applicable state laws and review
practice-specific insurance contracts. Why
Practices Relies on Insurance Only
Billing? There are various reasons why any
practice would rely on Insurance Only billing
as a sole source of practice collections, some of
them are listed below Absence of billing
team Practices find it difficult to hire
experienced billers and coders for their medical
billing specialists. Medical billing and coding
is a specialized task that requires a specific
set of skill set. Practices struggle to form and
retain an expert billing team as payroll and
overhead costs could be really high. Due to the
absence of a billing team, providers are stuck
only with the claim submission process and cant
take follow up on every submitted claim. This
could lead to accepting reimbursement paid by
insurance carriers without appealing their
decision.
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Why Are You Losing Money with Insurance Only
Billing?
The provider manages all Generally, small
practice owners or solo providers try to manage
everything on their own. This includes doing
medical billing for their practice. As healthcare
providers are not trained medical billers, they
tend to make mistakes during the entire billing
process. In such scenarios, healthcare providers
focus on submitting claims without an
understanding of billing guidelines and payer
reimbursement policies. They tend to use a
specific set of procedure/ diagnosis codes for
all submitted claims. As the provider is busy
with patient care, they wont be able to review
explanations of benefits and has to accept the
amount paid by insurance carriers. Fear of payer
audit Providers always have a fear of external
payer audits and due to this fear, providers tend
to accept insurance payments made by payers
without any question. As providers are not sure
about billing guidelines, even appealing a denied
claim is avoided due to fear of such payer
audits. In reality, often communications with
payers help your practice to understand billing
guidelines and avoid common billing
pitfalls. Absence of insurance coverage reports
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Why Are You Losing Money with Insurance Only
Billing?
Due to a lack of skilled manpower, practices
often dont have insurance coverage reports for
patient visits. Insurance coverage or benefits
report will help practices to understand if the
patients insurance is covering the planned
treatment and what is co-payment or unpaid
deductible amount. Without an insurance coverage
report, its really difficult to collect a co-pay
at the time of a patient visit. Medical Billers
and Coders (MBC) is a leading medical billing
company providing complete revenue cycle
services. We can assist you in receiving a
complete reimbursement amount for delivered
services. Our expert billers and coders are
well-versed in specialty-wise billing guidelines
and payer-specific reimbursement policies. Our
benefits report will help you to collect accurate
co-pays and unpaid deductibles at the time of
service. With our assistance, you can bring
financial sustainability to your practice through
timely and accurate reimbursements. To know more
about our medical billing and coding services,
email us at info_at_medicalbillersandcoders.com or
call us at 888-357-3226.