Physician billing is a complex and constantly changing field. Doctors need to depend on accurate billing services in order to keep the practices running smoothly. Every patient visit must be documented and submitted in accordance with strict insurance and government regulations. Claim denials and payment delays may crop up even with small mistakes. Many medical practices find it difficult to manage billing on their own as healthcare costs keep on rising and insurers tighten requirements.
Physicians now rely on professional billing services to counter this challenge. The billing companies are experts in medical coding, claims submission, payment posting, and denial management. They are professional in understanding payer rules and compliance standards. This helps practices get paid faster with minimal errors. Physicians can concentrate more on patient care by outsourcing billing.
Understanding Physician Billing
The process of physician billing involves the procedure of submitting claims to insurance companies for the medical services rendered to a patient. The tasks involved in physician billing consist of gathering patient information, confirming insurance coverage, coding each service, and pursuing payment. This process is guided by strict protocols established by Medicare, Medicaid, and some private insurers.
Billing errors are very common and costly that includes entering an incorrect code, neglecting to add a modifier, or not including documentation from the physician, which can result in payments being delayed for weeks. In some cases, a claim may not be paid at all.
Importance of Physician Billing Services
A physician billing service takes care of the billing process from beginning to end. The process generally starts before the patient ever meets with the doctor. The service will confirm insurance eligibility and the patient is informed of their coverage before the appointment. After the appointment, the physician billing service will code the procedures based on the codes established by the American Medical Association’s CPT codes and the ICD-10 codes established by the World Health Organization. The service ensures proper coding and assurance by identifying all the medically necessary elements of care.
The claim is submitted to the insurance company electronically, and the billing department will track the claim until payment is received. In the event the claim is denied for any reason, it is the responsibility of the service’s billing team to review the reason, make appropriate corrections, and resubmit the claim. The service will also post payments, settle accounts, and provide reports to the physician to assess the overall financial performance.
Why Physician Billing Is So Complex?
There is always change occurring within healthcare billing in the United States. Insurance companies change their policy and payment rules often. Additionally, the government sets new compliance requirements each year.
Each payer has a different claim style and different time frames. Medicare, Medicaid, and private payers have different claims rules and systems to follow. Keeping track of these claim variations takes skill and time along with constant training.
Benefits of Outsourcing Physician Billing
There are a few advantages to outsourcing physician billing.
- Accuracy: Billers have studied medical coding, payer rules and compliance and are trained. They have the same understanding of documentation requirements and are able to catch errors before claims go out. Clean claims will get paid faster and have fewer denials.
- Speed: A billing team is dedicated to processing and following up on outstanding accounts full-time, resulting in less time to pay and improving cash flow. Moreover, outsourcing billing will relieve practice owners resulting in less stress.
- Expenses: Training, hiring and maintaining billing staff are expensive when considering the associated costs; recruiting and hiring expenses associated with each employee are considerable. It may be more affordable to use an outside firm than to maintain staffing plus all the software licenses, updates, and compliance training that are always out there.
- Time: Instead of filling out paperwork, medical professionals can focus on treating patients. Staff will have more time to spend with patients and less time to chase down payers. Improved productivity will lead to enhanced patient satisfaction.
- Compliance and Security: Compliance is a cornerstone of medical billing. Every billing company must comply with HIPAA to protect patient information. All processes with data must have secure data solutions, encrypted communications, and limited access. Any established billing company will devote a significant amount of money towards cyber security to protect sensitive data.
They also monitor updates to governmental agencies and payers. It is very difficult for a busy practice to maintain this level of compliance independently.
How to Select the Right Physician Billing Service?
All billing services are not created equally. You want to consider the experience of a company when selecting a partner. Select a company with experience in physician billing and experience with your specific medical specialty.
Transparency is important. The best billing partners will provide reports and regular updates. You should always know the status of your claims and collections.
Confirm suitability with your technology. The service should be compatible with the current Electronic Health Record (HER) and practice management system; data should be shared between platforms seamlessly and with no manual effort.
Pricing structure should be considered, too. Some charge a percentage of collections; others have a monthly flat-fee structure, etc.
You are looking for a partner who will respond quickly, and can resolve issues promptly. Reliable communication is critical to keep the revenue cycle in order.
Future of Physician Billing
The future of physician billing is digital and data-driven. Billing teams will continue to be remote. The practice can access the best billing talent in the country, with no requirements to hire full-time. Compliance and cyber security will only become more important as data sharing becomes more prolific.
Physicians who adopt the technologies available to them and outsource wisely will be rewarded with cash flow, more efficient practices, and most importantly, more time for patients.
The billing services of physicians in today’s healthcare climate are considered an integral part of a medical practice’s flow of a given practice in the United States. They can help mitigate a lot of claim denials that many practice managers run into and they will keep the revenue flowing in between claims. With skilled billing assistance, physicians can focus on caring for patients instead of worrying about billing.
Accurate billing and efficiently establishing stable billable claims submission are about more than just billing. Partnering with an efficient and well-organized physician billing service may potentially give the clinic a new possibility of how practice flow will function.
Through outsourcing, providers can minimize costs by as much as 80%, with hourly rates starting at $7. Practices can reduce their administrative burden, so they can spend more time on patient care.
