Medical Billing Challenges Faced By Small Practices

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Medical Billing Challenges Faced By Small
Practices
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Medical Billing Challenges Faced By Small
Practices
Small and independent practices face unique
challenges today, starting from move away from
fee-for-service payment models to handling
billing and coding activities all by themselves.
The challenges of denial management have
multiplied. ICD-10 and value-based reimbursement
will have huge impacts on claims processing.
Practices need be proactive on dealing with the
constant change imposed by these outside forces.
Plus, due to implementation of Affordable Care
Act the administrative burden has also
increased, consuming lot of time. Small practice
owners are facing the choice of continuing to
evolve their current practice and patient
relationships or joining a large group where
everything from length of patient encounters to
billing practices are handled by the group. In
this article, we discussed some of the billing
challenges faced by small practices. Provider
Credentialing Provider credentialing/contracting
is the key process of revenue cycle management
for any practice. Credentialing process requires
continuous follow up with payer which may not be
possible for small practices, as they are busy in
all other activities of practice management. Once
you submit the credentialing application along
with required documentation, you have to
coordinate with payers and confirm if they
received documents or not. Providers busy in
patient care may not have that amount of time and
expertise over negotiations required at
contracting phase. Even though standard
documentation remains the same, but every payer
has unique credentialing requirements. Submitting
credentialing application for every payer and
taking follow up could take excessive amount of
time.
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Medical Billing Challenges Faced By Small
Practices
Insurance Coverage Most small practice owners are
happy to provide services to limited pool of
patients, as provider is assured about patients
insurance coverage. In case of any new patient,
provider is reluctant to accept any insurance and
expect patient to submit claim to insurance
carrier. So, considering new patient as self-pay
patient could ensure financial stability for
short term but it may not be good approach for
practice growth in long term. You must spend
sufficient amount of time to take out benefits
report for every patient and need to update that
report from time to time. Claim
Tracking Providers doing medical billing all by
themselves focuses on submitting claims without
keeping a track. Normally 10 percent or less
claims got rejected but in case of poorly
submitted claim this percent can be up to 30
percent. Providers busy in patient care and other
administrative activities dont take sufficient
amount of time for claim tracking. At the time of
contracting with payers, you can setup for
electronic remittance advice. After reading each
and every line item of EOB/ERA carefully, you can
find out if claim is denied, paid, paid partially
by provider.
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Medical Billing Challenges Faced By Small
Practices
Wrong Coding Providers doing medical billing all
by themselves also handle coding for every visit.
They has specific set of procedure codes which
they use for every patient visit. Medical coding
is requires in depth knowledge of coding
guidelines and payer reimbursements policies.
Using same procedure codes again and again for
every patient visit might attract payer audit.
You need to document every procedure carefully
and use accurate procedure code. Providers
generally makes mistakes in bundling and
unbundling codes or wrongly use
modifiers. Medisys Data Solutions is a medical
billing company providing complete billing and
coding services. Our billing services will
include charge entry, payment posting, denial
management, AR management, and billing reports.
With our complete RCM services, you dont have to
worry about any function of medical billing. Our
billing reports will help you to understand
number of claims submitted, paid claims, unpaid
claims, and claims needed attention. To know more
about, how we can assist you in managing billing
challenges, contact us at info_at_medisysdata.com/
302-261-9187
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