For physician practices, claim denials are frustrating. Medical billing and collections are complex and time-consuming, and a rejected claim only adds to the frustration.
According to AAFP, most physician practices should strive for a billing denial rate of less than 5% to enable successful cash flow. If you find that your practice is experiencing denial rates above this industry average, there is definitely room for improvement.
Turning to an experienced revenue cycle management (RCM) team to handle practice financials can make managing accounts payable and accounts receivable easier, while giving you peace of mind. Here are some of the benefits of using a billing service:
- Stay up to date. It can be difficult to remain current with CPT codes and to navigate the bureaucracy and rules of insurance carriers. An RCM service has the technology and the talent at its fingertips to stay on top of the latest regulations, so that your claims aren’t rejected for having the wrong information.
- Reduce errors. Services are trained to spot errors in patient demographic information, determine the need for preauthorization, and required documentation that, if forgotten, can cause a denial.
- Cut reimbursement times. A service has the bandwidth to submit claims faster, which helps you get paid in less time. This can be particularly helpful if your practice has a lot of Medicare or Medicaid patients.
- Improve practice financials. When you reduce your denial rate, your medical practice’s bottom line improves thanks to the steady flow of claims going out and revenue coming in.
- Actionable data. Every outstanding claim is tracked until it’s paid. Each explanation of benefits is audited for correct payment. Most RCM services can provide real-time reporting that gives you actionable detail on status of payment and any problem areas, allowing you to make changes to improve your billing long term.
- Have more time for patients. The billing account manager typically focuses on denials, rejections, appeals management, payment posting and monitoring, as well as printing, mailing, or emailing patient statements, so that you don’t have to. The practice management system can alert you if mistakes were made, so they can be fixed immediately, saving you time spent reworking claims that are denied.
- Interoperability. If you use a service that ties to the practice’s electronic health record and practice management system, the information sharing can help populate and speed up claims.
- Improved customer service. Your experienced RCM team is expert at explaining bills to your patients when they have questions.
Every small improvement you can make in reducing denials can have an impact on your practice’s bottom line. Look for a service that has a complete billing solution, from billing claims to denial management, and all billing related activities and support in between.
Your Quest Diagnostics team can discuss how revenue cycle management can help your practice. Talk to a representative at 1.888.835.3409, or try our calculator to evaluate your practice’s financial health.