Profitability in a medical practice is becoming increasingly challenging contract reimbursement rates “frozen” or declining while expenses are increasing. Recent estimates state that only 70% of claims are paid on the first submission. Of the remaining claims, 20% are denied, and 10% are “lost” or never acknowledged. 60% of unpaid original claims are never re-submitted. It is impossible to know how much that truly relates to in money as the charges can vary widely from service to service, but it still adds up and does so quickly.
If we consider the statistics above, approximately 18% of your services end up gratis.
The best medical practice management system should provide the tools necessary to build a strong, financially secure medical practice.
The basis for any good building is a strong foundation. The foundation of medical billing centers on patient data. Accurate collection of demographics and insurance information ensures that you are not “wasting time” attempting to collect from the incorrect payer or worse, getting stuck for a bill entirely for an uninsured patient. Utilizing Real Time Eligibility functionality in the billing software, office staff can be confident that patient coverage is in effect before services are rendered. The response from many payers will also include generalized benefit information which is extremely helpful in discussing up front financial responsibilities with the patient.
We are now able to safely start building our patient account as we enter the charges for services rendered. Whenever possible, it is best to utilize a charge data import function from your EMR software, typically via an HL7 format. This is much more time efficient and eliminates many keying errors or missed items.
Any proper building must be inspected, and so must your claims before they are submitted. An internal claim scrubber that utilizes the standard CCI edits is crucial in identifying possible coding errors and conflicts that would have just been denied by the payer. This is one of the ways the best medical practice management system can raise that initial pay rate from 70%.
All the rage currently is the “smart house”. Integrated systems throughout the building are all coordinated through a central area and can be programmed to operate “on their own”. The best medical practice management system for Mac, Windows and Linux should have many of these same “behind the scenes” activities to assist your office staff. Once electronic claims are transmitted, the system will wait for the proper acknowledgements. If a “front end” payer rejection is received, users are alerted and can address the issue within only a few days instead of weeks waiting for paper correspondence from the payer.
Your payments that are received via electronic remittances are constantly imported for you and automatically adjudicated. The system will alert the user when a denial has been received and a claim needs attention.
All of the hard work of a solid foundation, strong walls and integrated systems would go to waste if the roof was less than perfect. Your best medical practice management system should finish off with a highly visible AR module and quality reports that provide data to analyze and identify the strengths and weaknesses of your practice.
These tools above and many more are found in Iridium Suite best medical practice management software for Mac, Windows, and Linux based systems to assist the medical office staff in optimizing your claim reimbursements.