PCPs are Leaving Money on Table

According to a recent study published in the Annals of Internal Medicine, primary care physicians left a large amount of money on the table for services that were provided but not coded and billed. This research estimates that a single primary care physician could add $124,435 in preventative services to their practice’s annual revenue if coding and Billing practices were rectified. Researchers from Brigham and Women’s Hospital and Harvard Medical School used national survey data to conclude that a single primary care physician (PCP) could add $124,435 in prevention services and $86,082 in coordination services to their annual revenue if coding and billing practices were resolved. They also estimated that each PCP provided preventive services worth up to $40,187 in additional revenue.

The survey also found that although services were provided to up to 60.6 percent of eligible patients, billing codes were only used at a median of 2.3 percent. The survey suggests that having to navigate the eligibility, documentation, time, and component requirements of numerous separate codes may be too high of a hurdle to warrant the effort from PCPs to use prevention and coordination codes. The physician fee schedule plays a dominant role in how primary care and other physicians are paid. However, core features of primary care, first-contact care that is continuous, comprehensive, and coordinated are poorly matched with visit-based payments. 

Earn More with Outsourcing

• Avoid under-coding: As discussed above, most PCPs fail to code for preventive and coordination services as they fear payer audits. They prefer to be under code rather than receive more reimbursement for delivered services. With outsourcing, specialty-specific medical coders will assign accurate codes with modifiers (where ever applicable). It will help to receive accurate insurance reimbursements for delivered services.
• Avoid in-house billing: Most PCPs prefer to handle medical billing operations all by themselves. Medical billing and coding require a good understanding of billing guidelines and payer reimbursement policies. These policies and guidelines, keep on updating from time to time. So, PCPs who are busy with inpatient care may not able to stay on top of these billing updates, resulting in claim denials. Hiring specialty-specific medical billing and coding services will free a lot of your time which can be used to improve patient care. 
• Team of experts: Medical billing company has a team of experts in various functions of medical billing like charge entry, payment posting, AR management, denial management, and credentialing. When these activities are managed by a team of experts, accurate insurance reimbursement will be assured along with no fear of payer audits. 
• Insurance coverage report: Medical billing companies also share eligibility and benefits reports. You can use this insurance coverage report to find exact patient responsibility. In the case of non-coverage of insurance, patients are well informed, in advance, about their portion i.e., patient responsibility.

MedicalBillersandCoders (MBC) is a leading revenue cycle company providing complete medical billing services. We can assist you in receiving accurate insurance reimbursement while following billing guidelines and payer reimbursement policies. To know more about our medical specialty-wise billing and coding services, contact us at [email protected] / 888-357-3226