Business acumen is something that is generally lacking amongst health care professionals, particularly doctors or physicians. Physicians are primarily driven by clinical excellence, which they believe it to be pivotal to their existence, growth and credibility amongst the patient community. True, clinical excellence continues to be decisive factor even today. But, in a free economy where quality is generally standardized, practitioners’ financial stability and growth is not determined by clinical excellence alone, but innovative care, strategic expansion, and more importantly effective & efficient medical billing as well.
U.S. health care sector has always been at the fore-front of clinical innovations – adoption of improved clinical practices and technologies continue to enrich clinical experience and outcome. It is unquestionably true that patients are increasingly drawn towards practitioners with innovative attitude. As a result, many practices that are incompetent to reinvent themselves may slowly be on their way out.
Practice expansion too is something that is generally neglected by physicians – many are happy with single-outlet practice. But it is quite possible that competition may gradually reduce what once used to be profitable practice to a loss-making one. To offset such adverse impact, it is prudent to think of expanding your practice base to regions with positive growth prospects.
Billing complexity is a major reason for practices’ financial woes. With fee-for-service completed replaced by health insurance reimbursements, physicians have entered a multi-payer environment characterized by region-specific rules on Medicare and Medicaid, diverse fee-schedules, and overtly strict reimbursement policies. As a result, delay and denials continue to pile up account receivables and erode practice revenues. The situation has grown so alarming that medical practices fail to collect 25% of the money they are owed; $125 billion is left in the bag as unpaid claims; Only 70% of claims are paid the first time they are submitted; of those denied claims, 60% are never resubmitted to payers; and medical practices never pursue 18% of claims at all. While payers (whether Medicare, Medicaid or private health insurance companies) are justified in refusing or withholding claims with inherent billing and coding errrors, physicians could still have averted revenue loss of this magnitude with collaborative partnership with billing companies.
Maintaining financial stability will be even more challenging post the series of recent health care reforms – Medicare cuts, affordable & ACO model of care, mandatory EHR compliance, HIPAA 5010 compliant patient privacy and security, and ICD-10 based billing & coding. If Medicare cuts are indeed brought on, physicians will have to forego a considerable portion of their reimbursement. ACO model of care too is designed to rationalize reimbursement. While mandatory EHR compliance, HIPAA 5010 compliant patient…