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Medical Billing for Private Practices: Don’t You Want to Get Paid?

Health Insurance Companies Process 1 in 5 Claims Wrong

You know medical billing is a crucial part of your private practice, but why exactly, is it so vital? There are many reasons that all boil down to the same thing: it’s a matter of survival.

The majority of patients do not pay in full for private practice office visits with cash. Sure, some patients may pay copays by credit card before they leave your office but, in most cases, you must bill the individual’s insurance company for reimbursement for services rendered.

The majority of patients do not pay in full for private practice office visits with cash. Sure, some patients may pay copays by credit card before they leave your office but, in most cases, you must bill the individual’s insurance company for reimbursement for services rendered.

Solo practitioners rely heavily on revenue cycle management, timely submissions of claims, and reimbursement from insurance carriers for their very survival. Unfortunately, it’s not uncommon to find a private practice physician waiting weeks if not months for reimbursement.

Why do private practices struggle with billing tasks?

One of the main reasons why small private practice physicians struggle with medical billing is that a vast number of medical billing companies don’t typically work with small or solo practices. Why? Because these types of accounts are smaller.

The majority of medical billing companies charge a certain percentage of overall collections generated from the billing services they provide Smaller revenues equals smaller profits for the medical billing company.  Unfortunately, it’s as simple as that.

So why not hire someone in the practice to take care of the coding and billing? Many doctors do. However, today’s healthcare billing practices can be quite convoluted.

A number of rules and stipulations apply to claims submissions depending on whether you’re billing Medicare/Medicaid, veteran’s insurance providers such as Tricare, or one of the many private healthcare insurance companies in the United States.  Each of these carriers has different provisions and guidelines as well as time limits for filing claims.

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How important is medical billing for private practices?

It’s especially important for private practices to bill out as quickly and efficiently as possible. Revenue has to be generated in order to keep the office open and meet payroll and expenses. And even doctors need to earn a salary. You need and deserve to be paid for your services.

An overwhelming majority of small and solo physician practices continue to utilize in-house billing with varying degrees of success. Medical billing is vital for a private practice…if the doctor wants to get paid.

In order to get paid, claims for services must:

  • Be submitted in a timely manner, and
  • Contain the correct codes for procedures, treatments, and services.

If a practice has a healthy revenue cycle management process and a physician pays close attention to it on a regular basis, in-house medical billing may be successful, depending on the experience, qualifications, skills and knowledge of the individuals tasked with coding and billing.

Should you stay in-house or outsource medical billing?

In certain scenarios, in-house medical billing can be more efficient than outsourcing. However, the key is always to generate the highest return on investment. So in most cases, a medical billing company can save you money on overhead costs and employees’ wages, reduce the risk of errors, and provide consistency as well as transparency.

Making a decision to maintain in-house medical billing or deciding to outsource is a decision that must be made with care. Medical billing processes are the bread-and-butter of a private practice.  The bottom line is that if you’re not billing for services rendered in a timely manner, you’re not going to get paid in a timely manner.

Even a solo practice or small practice can benefit from outsourcing medical billing in order to:

  • Increase cash flow.
  • Get paid faster (professional medical billers that focus only on the billing process can reduce errors that result in a claims denial).
  • Eliminate significant in-house costs, including a medical biller’s salary, their benefits, the lost productivity cost when they are sick or on vacation, and the specialized computer software they require to perform their job functions effectively.

A specialty-specific private practice can also opt for a billing service that focuses on specific healthcare fields like urology, orthopedics, or oncology. This specialized, focused knowledge of accurate billing codes and procedures can streamline claims processing and facilitate faster reimbursement.

Increasing cash flow

In order to improve and increase cash flow, receive faster payments, and get reimbursed so you can pay your own bills, you can take a number of steps to enhance medical billing efficiency in your practice:

  • Whenever possible, utilize your static and mobile EHR technologies to code for services as soon as possible after a patient encounter. This helps reduce incorrect or missing codes.
  • Always verify eligibility of benefits and patient demographics to avoid delayed or denied claims. It’s recommended that private physicians check for eligibility at the time the appointment is made. You should also check one to several days before the actual appointment, and again when the patient is in your office.
  • Tracking is essential for key performance measures such as accounts receivable, days in accounts receivable, and accounts receivable over 120 days.
  • Take advantage of EHR systems that enable you to communicate easily with billers for optimal outcome. Communication (i.e. flags or notes) can assure accuracy and the correct usage of CPT and ICD codes to help streamline claims processing and reduce the amount of denials.
  • If you don’t have to time to stay up-to-date or on top of your in-house billing, consult with professional medical billers. At the very least, utilize EHR systems and technologies that incorporate practice management, medical billing and coding, and other customizable options to maximize your potential for timely reimbursement.
  • Train staff to collect a minimum of 90% of co-pays at the time of services rendered, which can significantly improve cash flow.

There is no doubt that medical billing software for private practices is essential not only for the health of your practice, but for the health of your own wallet. A number of EHR systems today incorporate practice management software that streamlines workflow and billing processes with an integrated clearinghouse.

They also enable the ability to analyze and manipulate data that helps you stay on top of your practice, your billing and coding practices, and most importantly, your reimbursement rates. After all, you deserve to be paid for the healthcare services you provide.

Does your medical practice have in-house billing or do you outsource your medical billing? Let me know in the comments below.

Aiden Spencer

Aiden Spencer is a health IT researcher and writer at CureMD who focuses on various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, electronic health records, Medical Practice management and patient health data. You can get in touch with him on Twitter: @AidenSpencer15

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4 Responses to Medical Billing for Private Practices: Don’t You Want to Get Paid?

  1. I work for one neurologist and I am the medical biller. But we use an outside billing company that we seem to pay a lot of money every month, with very little revenue to us. I want to know what it would take to do all the in house billing and what billing software is the least expensive and top rated, as our Dr would like to eliminate the outside billing company since I am the one doing of the billing. Any advice?

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Capture Billing helps medical practices by reducing their insurance accounts receivable and getting claims paid faster, allowing doctors to focus on providing quality healthcare to their patients without the stress of doing their own medical billing.

That’s why we developed Capture Billing’s Rapid Revenue Recovery System to keep our clients’ Accounts Receivables down and their revenue flowing.

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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