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4 Issues with Physician Billing Services that Affect the Physician’s Business Lifecycle

As physicians begin to operate at full capacity, patient access, and physician revenue cycle management functions that tend to be complicated will again be an issue. Unless your business has used the recent shift in focus brought with COVID-19 to upgrade financial systems and also resulted in the same situation. 

With portions of the physician billing services still managed manually, organizations rely on human intelligence to be solely responsible for staying up-to-date with the massive, ongoing changes that occur within the complex third-party payer system. By enlisting artificial intelligence (AI) and machine learning technology, physicians can tame the repetitive tasks while using current and the most latest information. 

Looking at several individual areas in the overall physician revenue cycle management, it is possible to envision the revenue improvement potential brought by advanced technology and tech-enabled automation. Practitioners can face the following issues with physician billing services in their payment lifecycle; 


Getting Authorization For Patient Care Through Insurance Payers:


Most of the physicians require prior authorization (PA) approval from the insurance payers of the patient. From inpatient medical services to complicated medical procedures and lab testing to most surgeries, the health insurance payers use PAs to control costs and manage the medical services. 

The physicians who use an AI-driven PA solution would greatly reduce the time necessary to complete each request and ensure that they are done accurately. Utilizing resourceful technology with machine learning capabilities and predictive analytics technology, information is obtained from insurance payer clearinghouses, approval submitted and results monitored 24/7. Physicians should acquire the help of specialists for physician billing services in order to handle complex management associated with PA to manage them precisely. 


Strive To Collect the Patient Portion Before Arrival:


Medical staff should make sure that the PA is in place before the patient arrives at the physician’s office. Administrative staff should analyze the ongoing revenue cycle practices and accurately estimate the outstanding balance. With more patients participating in High Deductible Health Plans, it is essential to collect that payment before providing healthcare services to the patients. Since the annual maximums can be overwhelming for patients. 

According to the Centers for Medicare and Medicaid Services (CMS), in 2018 consumer households were responsible for 28.4% of the National Healthcare Expenditure (NHE) i.e. worth of $3.6 trillion.  CMS has further notified that those figures were expected to climb on average by 5.5% per year and due to the rise of the COVID-19 crisis, this figure is expected to grow continuously. 

Actually, the optimum solution for physician billing services may be a fully integrated patient access solution that can prior authorizations, insurance verification, benefits eligibility and patient portions due to all-in-one package that interacts with the organizations’ medical records or medical billing system.  


Prevent Claim Denials:


Due to the increasing number of medical claims being denied for a variety of reasons result in significant revenue loss. It leaves the medical practitioners with more than half of their medical claims to languish unresolved. It is a key solution to find a repeatable successful strategy during the times of declining margins and shifting care criteria. 

As part of a comprehensive Account Receivable management process, systematically processing claim denials through the advancement and AI-driven technology would ensure that complete revenue is captured for those amounts that have been abandoned. With a tech-enabled solution remedy, the focus can be on resolvable claims with following-up processing 24/7. 


Account Receivable Recovery Services To Manage Uncollected Debt:


Once the claims have been submitted, and all AR efforts have been exhausted, medical practitioners are left with the uncollectible bad debt. Usually, most of the practitioners left from emergency care or diversion transfers the portion embarked for collections or to be written off as charitable care or bad debt. But if they tend to acquire expert solutions for physician billing services then they can resolve these undesirable issues and drive maximum reimbursements. 

Insurance discovery brings AI-supported automation to the bad debt conversation and solves the issues that can be created when the patient first arrives at the physician’s office for medical treatment. 

With smart and AI-driven physician billing solutions, one can simply monitor the unknown coverage and detect claims resubmitted with 50% of the collection rate. The insurance discovery process works especially well with the Medicaid and commercial payers. Besides, it can also add value to the patient unaware of their co-pays or financial responsibilities. 


Due to the complex and strict policies for healthcare reimbursements and insurance coverage, it has become extremely challenging for physicians to ensure smooth cash flow for their business. It is not a good approach to simply rely on the patient’s word of mouth and not verifying their information in advance. Sometimes, although no fault but simple negligence can damage the financial health of your organization. Due to poor collection management, revenue margins are deflating for the medical industry. Today, inpatient organizations need to proactively engage in the solutions that can help to streamline the overall lifecycle of physician billing services. 

With the help of a reliable medical billing collection agency, physicians should shift towards the advanced solutions of medical billing and coding services in order to save time and increase revenue. Contact Us! To schedule a free business consultation so we can help you to combat the revenue crisis with advanced and efficient billing solutions. 

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