As the overall cost of healthcare continues to increase, so does the complexity of billing and collections processes. Higher demands for patient access, more complex claims submissions processes, and increased patient responsibility are resulting in escalated risk of claims rejections, denials, resubmissions, appeals, and diminished reimbursement.
Quest Diagnostics recently conducted a revenue cycle management survey asking providers about their biggest pain points related to the physician billing process. The survey builds upon a 2017 survey to highlight how perceptions have changed over the last several years, and gain additional insights on how practices are responding to these challenges.
A majority of respondents told us that denials from insurance was their biggest pain point, followed by difficulties in patient-payer collections and denials from Medicare/Medicaid. This is a notable change from 2017, when providers were more concerned with employees having limited knowledge and resources to keep up with billing policies and requirements.
One explanation for this increased emphasis on denials and collections is likely due to the longer wait between patient visit and final payment or reimbursement. Where most respondents in 2017 stated that they could expect payments within 30 days, the majority are now looking at a reimbursement window of 15-45 days. These prolonged reimbursement periods have a negative effect on the bottom line of small practices by restricting and reducing the predictability of cash flow throughout the business.
While there was growth in the number of providers achieving denial rates of 1-5% compared to 2017, the average denial rate across all respondents rose from 14% to 17% over the last two years. This indicates that while some practices have been successful at reducing denials, a similar number of practices, or more, are seeing denial rates increase. According to respondents, the primary causes for denials are nearly identical to those experienced 3 years ago.
We also asked providers if they were currently using an outside billing company. Only 30% said that they were working with a billing services provider, a 2% increase over 2017. Among those respondents who are using an outside billing service, more than 80% expressed satisfaction. Across all respondents, the top 5 most compelling features of medical billing services were time savings and overall efficiency, denial management, increased collections, keeping up with payer requirements, and claims tracking.
When comparing the results of these 2 surveys, one takeaway is clear: the complexity of modern billing processes continues to hinder practices’ ability to submit claims and collect payments. Even when payments are collected, the reimbursement period is growing longer, interfering with cash flow. And while most practices using outside RCM support express satisfaction with the services received, many have yet to invest.
To see more results from our 2019 RCM survey, download our latest white paper, “Improving practice financials: A practical guide to revenue cycle management.”