Healthcare Providers And Turning A Profit In 2016

By James Michaels


When ICD-10 got released, it caused a panic amongst healthcare providers. Many doctors were scrambling to find certified coders. It was not easy to find these coders because a lot of medical billers in the industry did not prepare for the drastic changes. Many coders thought that the switch from ICD-9 to ICD-10 was going to be a breeze. However, they now see how wrong they were. The codes are complex and often hard to figure out. A person must come to the realization that they can get better with practice, education and experience.

Healthcare is seeing a dramatic change in medical insurance and reimbursements from insurance companies. Many insurance companies are not paying out on claims what they used to. They are also telling doctors what they feel is medically necessary for a patient. The physician may feel that the patient needs two blood tests for the same issue in a given week. The insurance companies may deny your claim and say that they are only paying for one of the blood tests. The reason was because they didn't see it as being medically necessary.

Billers that work for outsourced companies say that they have good results collection on claims. A claim is hard to collect on if you don't have the proper codes and paperwork filled out. Most doctors today say that their job has more to do with billing than treating a patient. It seems like the system is set up so that you spend 10 to 15 minutes with your patient and 20 minutes with your billing for each patient. Doctors cannot handle doing everything at once. Many physicians find themselves working 12 hour shifts several days a week in order to manage their billing and patient records. It is important to allow a professional ICD-10 coder to handle your billing.

A lot of medical billers say that the problem is not with the insurance companies. The problem is with incorrect billing and coding. I find it interesting that most medical billing companies are seeing 20% to 35% more revenues for their clients than doctors who choose to use in house billers. Don't you find it interesting that these medical billers are getting more money when they send their claims in? This means that the problem is not with the insurance companies. The problem is with the billers doing your coding.

Being a physician today means managing your billing with authority. It is about having your own internal audits with the person that is handling your billing. If you are losing money on your claims, try to find out why. If the medical biller can't figure it out, trying hiring a medical billing consultant that can tell you what is going wrong. Many times, people are shocked to find out that they have more problems than they thought.




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