Medical Billing Challenges for Group Practices

Group Practices Remain Competent by Outsourcing Medical Billing

While Billing for various payers most group practices face specialty-specific billing challenges. If your RCM/billing team doesn’t include billers and coders from the same medical specialty then practices might face claim rejections and denials. Group practices struggle in finding specialty-specific billers and coders. Hiring such specialty-specific RCM experts could cost a lot or group practice may not have that number of claims to submit. The medical billing company is associated with multiple group practices of the same specialty in your area. So they might have a team of specialty-specific coders and billers who are well-versed with payer-specific and medical specialty-specific billing guidelines. Connecting with such medical billing company will not only increase your practice collections but also keep your medical billing process error-free.

Receiving claim denials in medical billing is quite normal. But having a competent denial management team ensures, you are working on denial codes and resubmitting corrected claims. Not all group practices can afford to have a fully functional denial management team due to cost constraints. Ideally, the denial management team should include coders, billers, Accounts Receivable (AR) experts, benefits verification executives, and providers. Medical billing company hires industry experts from various medical billing background to work in the denial management team. Medical billing company ensures that every submitted claim should get paid which ensures lesser write-offs.

As mentioned earlier, even though group practice owners want to focus on medical billing, they can’t dedicate much time. Receiving an accurate reimbursement for delivered services is a challenge for group practice owners. Some of the reasons include administrative burden, ICD-10 implementation, pay-for-performance, contract management, Affordable Care Act, No Surprise Act, and constantly changing billing guidelines. Managed care contracting is an integral part of medicine for virtually all healthcare providers. Not managing or accepting bad contracts will have a severe negative impact on group practice revenues.

Medical billing company helps group practices to get all their rendering providers to get enrolled for all major payers. Provider enrollment and credentialing is a tedious and time-consuming process and most group practices tend to bill as out-of-network for some payers. Getting your all rendering provider credentialed and enrolled is really crucial. Even though reimbursement amounts for out-of-network are usually much higher than in-network, sometimes the difference between $6,000 and $40,000, payers makes them much more difficult to collect. There are a variety of unpublished and unknown internal edits, third-party contractors, and double-sided red tape that has to be navigated.

Outsourcing is More Cost Effective than In House Billing

Outsourcing medical billing is more cost-effective than in-house billing for various reasons. Some of the key reasons are discussed below:

• In-house billing involves a lot of operational overheads apart from salaries and employee insurance. The in-house operational overheads include: finding and retaining highly trained and certified billers and coders; licensing for software; clearinghouse fees; statement fees and postage (including the cost of printing); computers, laptops, and other hardware.
• In-house billing might lead to lesser practice collections. Medical billing company shares insurance coverage report for every patient visit. This helps practices to collect co-payments and deductibles at the time of service only. Insurance coverage report also helps in sharing exact cost estimates with the patient which helps them to understand patient responsibility.
• On average, the cost of reworking on denied claims approximately ranges from $15 -$25. If your group practice is receiving higher claim denials, the cost of rework is also high. Experienced billers and coders from medical billing companies ensure fewer number of denied claims. The medical billing company tracks the claim status of every submitted claim and resubmits the denied claim on time.
• Billing errors can create a potentially large hit on your revenue. Errors include inefficient collection policies, incorrect coding, errors with patient registration and insurance verification, and lack of documentation with a claim. Using wrong modifiers or procedure codes to receive more reimbursement could lead to external payer audits.
• Most medical billing companies offer flexible billing options where you can choose a billing plan as per your group practice’s requirements. You can either hire an experienced biller or a coder as FTE (Full Time Equivalent) basis where that expert resource will be working on your billing account as a full-time resource. Or the medical billing company will charge a fixed percentage of your monthly practice collections.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. We assisted group practices of various medical specialties in receiving accurate insurance collections from private and government payers. To know more about our billing services and pricing plans contact us at: 888-357-3226 or drop an email at: [email protected]

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