Medical billing in small practice is one of the keys to the financial status and sustainability of the independent healthcare providers. As opposed to billing departments within a large hospital system, small practices usually encounter staffing shortage, a rapidly changing payer environment, and tedious administrative work. Proper medical billing in that kind of environment is not only significant, but it becomes a necessity.
This blog tells you all you need to know about small practice medical billing, the challenges that can come your way, how to strategically overcome them, the advantages of outsourcing this process, as well as how the right medical billing partner can make your clinic flourish.
Why the Small Practice Medical Billing Publication Has to be Special
Small practice medical billing is not the same as that of hospitals or huge multi specialty clinics. The smaller practices tend to work with lesser budgets, less support staff and tighter margins. A rejected claim or a delayed reimbursement is capable of causing an extensive blow on your monthly revenue stream.
- Also, independent practices commonly:
- In house billing without certified coders
- Occasionally use non-specialised or out of date billing software
- Experience high turnover of staff, breaking their billing continuity
That is why billing solutions used by small practices must be customized to the requirements in operating the practice and the number of patients.
Small Practice Medical Billing Common Challenges
Today we will consider the most typical challenges of a small healthcare provider which apply to the billing:
1. Limited Resources
Smaller teams constantly have to deal with many duties. It is also possible that your front door personnel are doing insurance billing, coding, and patient registration. Such switching results in errors and lacking of revenues.
2. Coding Mistakes
In the absence of certified coders, it is normal to have errors in CPT or ICD-10 code. These mistakes may result in rejections and under payments due to which your revenue cycle is delayed.
3. Delayed Reimbursements
Small practices are not always in the position to pursue unpaid claims or even tracking rejected claims. This leads to loss of revenues in the long run.
4. Weak Claim Tracking
Billing is not about submitting claims but then it is following up. There are no specific AR tracking, which can lead to the failure to pay claims forever.
5. Confusion on Payer Policy
The requirements of the payers are continually evolving. It becomes a problem because small practices do not always have time to keep up and this drives them to non compliances and denyals.
All these difficulties indicate to a need of a more organized, professional small practice medical billing system.
The Arithmetic on Bad Billing
Poor billing could slash the revenues of a small clinic into half. Consider this:
- Approximately 2030 percent of the claims which are submitted yield a rejection in the initial presentation
- An average of 5-10 percent of revenue is lost to practices when reimbursements are missed
- It costs the average of more than 25 dollars to appeal a denied claim in terms of labor time.
Here are some figures, which demonstrate that small practice, the medical billing errors are not only a nuisance, but also costly.
Advantages of Efficient Small Practice Medical Billing
The benefits of a well-optimized billing process are obvious. Now we will consider how your clinic can gain the advantage of the effective billing system:
1. Increased Revenue
Correct claim formations and quick follow-ups minimize the denials and accelerate reimbursements.
2. Fewer Errors
Certified coders who are well versed with ways of avoiding expensive errors are employed in professional small practice medical billing services.
3. Quicker Rate at which Claims are Processed
The early completion of filed claims with the correct documentation guarantees your compensation within a short time.
4. Better Compliance
Keep up with HIPAA and payer-specific requirements with a minimum of fuss.
5. Patient-Centred Attention
Take the paperwork off the hands of your staff so that they can focus on the most important thing in their line of duty and that would be patients.
Is Outsourcing of Medical Billing Good at Small Practices?
The practice of small practice medical billing has become a very trendy outsourcing service and rightly so. It avails the services of well-trained billing professionals without incurring the expense of employing permanent employees.
Advantages of outsourcing:
- Cost-Efficiency: Pay a fixed fee, or percentage of collections-no employee wages or training expenses.
- Expertise: Resource access to payer groups and/or work with between payer policies and modifiers and specialty codes.
- AR Management: Your partner does the follow-ups, appeals and re-submission.
- Technology Access: Technology advanced billing software and reporting tools-no additional investment required.
Outsourcing can be ninth addition a relief to take the pressure off the billing process and to become more profitable whether you are opening a new clinic or expanding on an existing one.
What to seek in a Small Practices Medical Billing Partner
The correct selection of billing partner is the secret of financial success of your clinic. The following is what to consider in a small practice medical billing provider:
Exposure to the Little Practices
Never focus on companies that target hospitals or huge systems. Your needs are not the same, your billing partner must know that.
Certified Coders
Make sure that they use AAPC or AHIMA certified coders who are familiar in your area of specialty.
Transparent Pricing
Seek flat fees or charge of percentages without additional expenses.
Technology Integration
They ought to be compatible with your existing the EHR or the practice management software.
Custom Reporting
The partner is supposed to give regular reports on collections, claims and denials in language that can be understood.
HIPAA Compliance
They are required to observe tight security measures in order to safeguard patient information.
The iMediSphere solution helps small practices in the following ways.
We are iMediSphere and focus on delivering full service small practice billing products that help independent healthcare providers realize the most in collections and know the least about medical billing.
This is what makes us different:
- Bill-to-Collection: We make sure your eligibility checks are done and your AR followed up.
- Certified Medical Coders: Our staffs are knowledgeable on the specialty billing intricacies.
- Clear Communication: You will be well put in the picture about the status of your claims.
- Technology Support: We become part of your systems without interference.
- Custom Solutions: If you operate as a solo practitioner or hand complete programs we design our products to fit what the scale of your company.
By turning to iMediSphere, you also partner with a revenue-maximizing ally.
Case Study: Real Results:
To see an example of a real-life turn around of a struggling clinic because of small practice medical billing, let me tell you about a clinic in Memphis, Tennessee:
Background: A two-physician set up in Texas had a denial rate of 35 percent and more than 80,000 dollars in aging claims.
Our Action:
- Did an entire audit of their billing system
- Denied claims were re-coded and resent issued
- Adopted a transparent determination of eligibility methodology
- Trained employees on simple requirements of documentation
Results:
- The rate of refusal was reduced in 3 months to 12%
- Repaid out dated claims $64,000
- Bumped up monthly collections by 28 percent
- It is the strength of proper professional small practice medical billing.