Medical Billing Challenges for Private Physician Practices

A private medical practice’s success is reliant on revenue cycle management, accurate and timely claims submissions, and prompt reimbursement from insurance carriers. That said, it’s not unusual for a private practice physician to have to wait weeks or longer to receive payments. Even when reimbursement is received, it’s often much less than they charge for services.

Other challenges for private practices today include seemingly ever-changing requirements of the upcoming implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Not only that, but your projections for your 2019 payment adjustments anticipated by review of 2017 performance data. Choosing between reimbursement models has also added confusion to the mix. So too have the new codes implements in the ICD-10. So too does tracking accounts receivables and…

The changes in regulations are especially challenging for smaller private practice physicians. Value-based care models will affect all patients, not just those on Medicare. Quality reporting is just one of the many aspects of today’s healthcare regulations that incur challenges for private practices. Time is a huge issue for many physicians.

Are you staying up-to-date on CMS guidelines and reporting requirements? With more patients opting for private pay due to high-deductible health care plans, are you placing your practice at risk for non-payment for services rendered? Today’s healthcare environment is a balancing act for many physicians.

A medical billing company keeps track of it all to increase your chances of collecting fees due from patients. Yes, a smaller private practice has to work harder today to get paid, but with a reputable billing company working with you, your bottom line sees the benefit.

Optimize your medical billing for private practices 

Accurate medical billing is vital for private practices. Payments rely on:

  • Proper management of claims
  • Accurate data entry for patient information
  • Correct codes for procedures, treatments, and services
  • Timely handling of rejected or denied claims

Healthy revenue cycle management relies on

  • Verification of insurance eligibility
  • Prompt submission of claims
  • Timely follow-ups
  • Monthly assessments of finances

Let’s face it. You’re busy. Outsourcing your medical billing to a professional company that focuses on this aspect of healthcare delivery frees up more time so you can focus on your patients. Relying on a medical billing company also reduces risk of errors and provides billing consistency.

Specialty-specific practice billing challenges

A number of challenges also exist for specialty-specific physician’s office billing practices. Reducing rejected claims or denials, and of course, reaping the benefits of value-based practices relies on staying up-to-date on coding methods for specific niches in healthcare. Today’s specialties often require special handling when it comes to billing due to pre-certification and adequate authorization. Expertise in knowing how to handle the diagnostic coding for specialties is vital.

Increasing your revenue cycle management practices has the potential to maximize your cash flow and increase efficiency. Reduce A/R days with timely claims submission within three days of service date. Outsourcing your billing tasks to a company that focuses only on billing practices makes it easier to stay on top of claim status, delays, or requests for additional information.

Such specialized and focused knowledge regarding accurate billing processes streamlines claims processing and ensures faster reimbursement.