I quickly snapped to attention!  Let me get this straight, according to every politician and insurance company executive, the plan to control the cost of healthcare is for physicians and healthcare providers to improve the quality of care while lowering the cost of care……all while insurance companies profit billions of dollars per year!  So doctors are expected to work harder, for less money, while insurance carriers profit billions!  I had to say it over and over again to really believe what I had heard.  I was shocked!

At a time when patients forgo care due to the cost of their co-pays, deductibles, and coinsurance…..insurance companies profit billions.  At a time when doctors are forced to fight to get paid for services they’ve already performed, insurance companies profit billions.  Even after healthcare providers jump through hoops of fire to get claims accepted for payment, the insurance carriers pay less then their own contracts obligate them to pay (United Healthcare was recently fined $350 million for underpaying contracted physicians)……while insurance companies profit billions per year!  Putting these revelations together was astounding and angering for me!

With all the debate about healthcare reform, why is everyone avoiding the obvious?  The problem is not physicians and healthcare providers; the problem is insurance companies!  They want doctors to take less money while working harder (as if 16 hour shifts in the ER aren’t enough), all while they profit billions of dollars per year.  Patients can’t afford coverage and care, doctors can hardly get insurance companies to pay for treatments, but insurance companies point the finger at everyone but themselves!

On the way out of Salt Lake, the flight plans changed to include a layover in Las Vegas (no big deal).  Upon arriving in Las Vegas, it quickly became clear that there would be no flight to San Francisco!  So with the help of a gate agent, I boarded a flight to arrive in Oakland (sounds good considering that my first appointment for the day was in Oakland). 

After meeting with clients in both Oakland and San Francisco, I thought the rest of my day was all down hill.  Only while checking in at the San Francisco airport, I learned that my flight home had also been cancelled.  With the help of another excellent gate agent, home seemed within reach!  With new boarding passes in hand, I boarded a flight to Pheonix, with one last flight to Salt Lake from there! 

So, I set my personal best record for airports in a single day: Salt Lake to Las Vegas to Oakland, then San Francisco to Pheonix to Salt Lake.  I’ll do anything for clients!  All in a days work!!

While providers are battling tooth and nail for their receivables, they frequently set themselves up for disaster.  One of the easiest yet frequently overlooked areas of the physician revenue cycle is information intake.  Upon intial contact with each patient, staff members need to be responsible for gathering all the necessary information. 

Failing to collect copies of the patients insurance card and demographic information will leave billing staff hung out to dry.  Without all of the demographic information, claim forms and appeals cannot be completed.  The insurance card contains detailed information pertaining to each patients particular insurance plan.  Sure you have the phone number to the big insurance company, but is this particular patients plan administered by a different department?  Has the payer ID # changed, or could it be particular to the plan? 

While battling these vicious insurance companies, why fight with one hand tied behind your back?  Do yourself a favor, be sure to collect accurate demographics and always get a copy of both sides of the insurance card.  Your bank account will thank you!

In an effort to rein in costs, congress has approved this measure without giving much consideration to the end result.  Physicians in all specialties are faced with the task of absorbing these cuts in order to continue to treat patients desperately in need of quality care.  Meanwhile, seniors are facing the reality that their doctors may no longer offer treatment to Medicare patients. 

Many people believe that doctors sit on the golf course while earning millions of dollars per year.  Although this may have once been a reality, I can assure you that this is no longer the case.  Physicians and healthcare professionals in most specialties have been facing the reality of shrinking profit margins year after year.  The constantly evolving insurance reimbursement process has made it more and more difficult for physicians to receive payments for services they’ve already performed.  With the growing cost of malpractice insurance, overhead, and billing expenses one can see how difficult it has become to run a profitable medical practice. 

With costs rising and reimbursements declining, how can we expect healthcare providers to handle a 20% reduction in reimbursement?  Many specialties rely entirely on Medicare patients to keep their practice afloat.  These certainly are not the highest grossing doctors in the nation.  If physicians can no longer afford to treat Medicare patients, where will seniors go for the treatments they need?  How will they manage to stay healthy without regular visits to the doctor?  These issues must be addressed in a timely fashion or seniors and healthcare providers will be hung out to dry!  Although there certainly is a need to control the spiraling cost of healthcare, squeezing physicians and seniors can’t be the only option.  How could we let this happen while insurance companies are profiting billions per year? 

The president of the American Medical Association, Dr. Cecil Wilson has recently spoken out against these cuts.  He’s calling for a thirteen month reprieve to allow for the opportunity to come up with different alternatives.  Hospitals, physicians, and pharmaceutical companies all oppose cuts to the fee schedule.  We will have to wait and see if the powers that be will allow this atrocity to take place.

In the workplace, employers and employees often feel as if they’re on opposite sides of the fence.  Employers feel as if their subordinates take no consideration of how difficult it can be to turn a profit while facing spiraling costs and a difficult economic environment.  While large corporations may be able to ride out the storm, small businesses rarely have this luxury (especially at a time when credit is difficult to obtain).   Most small businesses would close their doors if the balance sheet goes in the red for more than a few months or quarters.  On the other hand, employees often adopt a near sighted approach.  How could they expect me to afford a premium increase?  Should I just try and float without insurance for a while?  These questions often lead to resentment on both sides of the coin, but are the employers or employees to take the blame and the higher cost?

Looking for answers to this growing problem is not easy.  Where did the system go wrong?  Why is it so expensive?  Who’s to blame?  

Many people blame healthcare providers for the rising costs of quality care.  I can assure you this is not the case.  Providers are facing a myriad of challenges and roadblocks.  More so than ever, running a profitable medical practice is daunting task.  Like any other business, a medical practice will close if it can not cover expenses and afford to pay salaries.  Labor and leasing expenses are only the tip of the iceberg.  Practitioners are forced to pay for equipment, insurance, hardware, software, licensing, and more.  After establishing an office with all the appropriate resources, medical practices and hospitals must then attract patients in a very competitive marketplace.  

Yet with all these costs and challenges in their way, healthcare providers are not complaining about patients or labor or costs!  The largest problem facing healthcare providers is the insurance reimbursement process.  Contradictory goals of payers and providers are resulting in inefficient and difficult payment systems.  Insurance companies are more concerned with bottom-line profits and shareholders than they are about the care their members receive.  How can we expect doctors and healthcare providers to keep their offices open if they can hardly get paid for the services they perform?  Individuals believe that because they pay premiums, the insurance company will pay their doctor.  Unfortunately, this is hardly the case.  Health insurance claim denial rates can reach as high as 25% or more.  Many providers have outstanding receivables measured in the millions of dollars.  The insurance reimbursement process is so arduous that many medical practices never get paid and as a result close their doors forever.

Insurance companies use a wide variety of tactics to delay payments and deny claims.  Payers employ hoards of representatives charged with the task of fielding calls and scrutinizing claims.  Due to these tactics, insurance claims take anywhere from 30 days to more than 1 year to reach a completed status.  In most cases claims are delayed and denied due to inconsequential, irrelevant errors.  These errors result solely from the many difficult and senseless hoops that are placed in the way of the provider’s billing representatives.  This extremely labor intensive process of collecting from insurance companies costs providers a great deal of time and money.  

The only beneficiaries of this process are the shareholders of insurance companies.  The delays in payments result in interest earned for the time period in which the claim was delayed.  In many cases, providers never receive reimbursement for the services they perform.  These claims must be written-off as a loss by providers while insurance companies see these cases as victories leaving more cash on their balance sheets.  It appears that the primary goal of insurance companies may be to deny as many claims as possible; after all they answer to shareholders not providers or individual policy holders.  This gross abuse of power by insurance companies may be the biggest problem we face in the healthcare sector.  

The days when doctors sat on golf courses all day while making millions per year are over.  Now they must battle insurance companies tooth and nail for every claim.  If insurance companies paid doctors for the services they perform, perhaps we would see a reduction in costs related to providing care.  

Surely there is no easy fix to this problem.   We may find the answers by addressing the goals of big insurance companies.  Providing oversight and incentives for paying healthcare providers for the services they perform would be a good start.  If insurance companies focus on weeding out fraud rather than just delaying and denying payments, we could see an increase in efficiency and productivity in the healthcare sector that could be the start of controlling costs while maintaining a high standard of care.   For the sake of all Americans, hopefully we find an answer soon!

While many people think that doctors spend the majority of their time on the golf course while making millions of dollars, this is not actually the case. One cannot deny that healthcare is big business these days, but running a successful medical practice is a complex and often difficult task. After spending years in school learning the complexities of diagnosing and treating patients, most physicians emerge from residency with little knowledge of the business end of running a medical practice.

Recent graduates from residency are not alone in dealing with complex business of running a medical practice. Many experienced physicians find it difficult to turn a profit in this complex healthcare system. The biggest obstacle in the path of practice administrators is the ever changing insurance reimbursement system. The payers have the deck stacked in their favor, and they will use every card they have to delay payments and deny claims. It is for this reason that expert medical billing has become such a valuable component of many successful medical practices. In fact, hiring an expert billing company can mean the difference between success and failure for healthcare providers in all specialties.

So how do medical billing services make healthcare and medical practices become more efficient? Here is a rundown of ideas:

Healthcare providers can focus more on patient care

Administrative procedures such as collection of payments are a part of running an office. With medical billing service providers around, physicians can stop worrying about such tasks and instead, focus on providing the best healthcare possible.

Records are kept up to date

Proper tracking of transactions is always the key to having an efficient system. Medical billing and coding service providers offer maintenance of patient billing records. With an organized record of information, important details will always be readily available.

Medical billing experts can help healthcare practitioners comply with regulations

All efficient systems strictly follow rules and regulations. In the case of healthcare practitioners, it is the aid of the expertise of the medical billing and coding service providers that enables them to compliance with reimbursement regulations of Medicare and governmental agencies. Recent legislation has set the bar high in terms of penalties for non-compliance. Hiring an expert could mean the difference between profitability and failure.

Data Security

Unexpected emergencies can wreak havoc on any successful practice. When hurricanes hit or disaster strikes, the security of your patient data can bring unprecedented piece of mind. An expert medical billing company will safely store your data on reliable Oracle databases, housed in two separate, HIPAA and EHNAC compliant, secure data centers. Your valuable information will be available for viewing and download whenever, wherever you need it.

Fewer Errors

Just as physicians are experts in medicine, an expert medical biller is trained and experienced in the art of insurance reimbursement. With a focus on billing, these dedicated professionals can ensure a healthy revenue cycle.

Chronic health conditions

A sad reality hits us that the wrath of some diseases cannot be stopped that easily. With the changing lifestyle of people where health seems to appear last in the priority list, certain illnesses cannot be cured in the fastest time possible. Instead, they continuously attack immune systems. Certain diseases such as obesity, diabetes, and heart ailments are just some of them. Costs particularly start to balloon due to the increasing demand for the medicines taken as maintenance.

Medical Advances

General Inflation

When inflation rates increase, everybody gets affected by the rising prices of goods and services. The healthcare industry is particularly distressed, as medical care becomes less affordable for those who need it.

Rising healthcare provider expenses

Understanding the spiraling price increases in healthcare services can give everyone a better idea on what solutions to implement. As in any other kind of dilemma, knowing where to focus can give desired results.

Health practitioners charge for every kind of assistance that they give. Particularly in private hospitals, patients can always be expected to go home with a bill. That is why medical practitioners are also expected to somehow have the business management skills to be able to run a profitable practice.

So how does a medical billing service reduce overhead costs for healthcare providers? Here are just a few examples:

Lower overhead expenses

Processing payments can be very tedious especially to the doctor that needs to focus his attention mostly on the patients. That is why he may decide to hire his own employees apart from the secretary who is already full of workload-on-hand. When this happens, just like in any other business, the overhead expense will inevitably increase due to the additional salary expense. But with a medical billing service that is provided by a third party vendor, additional costs can be avoided and expenses can be controlled.

Less paper work means time for more patients 

To be able to finish all important tasks at any given time, delegation is the key. In the healthcare practitioner’s case where more paper work won’t  fit in to his schedule, somebody else’s help can be very useful. As someone who is also working for a living, a third party who provides medical billing services can afford the doctor more time for additional patients.  He will be able to accommodate more people who are in need of medical attention, bringing in more income to cover his expenses.

Eliminates Wasteful Spending 

The patient’s health record plays a vital part in the effectiveness of the medical expert’s treatment plans. That is why some bright minds have come up with a great idea of improving the system of managing and sharing health records. They gave birth to Electronic Health Records / Electronic Medical Records.

An electronic medical record is simply an automated version of the documents that make up one’s previous medical records. It is a more advanced system, as it gets rid of the manual process of digging through piles and piles of paper files just to get certain details in the patient’s medical history. It is composed of sections on the administrative components, laboratory system components, radiology system components, pharmacy system components, computerized physician order entry, and clinical documentation.