I often wonder how many claims (dollars!) per day are being rejected where providers do not appeal the adjudication. I imagine the numbers would be staggering!

The insurance companies know this little tidbit and use it to their advantage. Let's say an insurance company is paying out $1,000.000.00 per day in insurance claims. If they deny just 1/10% of those claims, it adds up to $1,000.00 per day. That's $1,000.00 per day that they get to keep that should have gone to you, the provider. Now let's project that out over the period of a year; $365,000.00!

That's not pocket change! In three years they have gained over one million dollars in revenues that should have gone to the providers.

I have been told that every time an insurance company has to physically touch a claim, it costs that company $150.00. Now, just think about that for a moment; if it cost them $150.00 just to touch a claim, don't you know they have done the math and know that more people do not appeal their decision than do appeal and they know that the cost of handling those appeals must be considerably less than the $365,000.00 they are keeping.

What's the answer? Appeal your claims! If every physician who had a rejected or down-coded claim appealed the claim, the insurance company's cost would rise. When it gets to the point of costing more than they can keep by shortchanging the providers, they will start paying the claims correctly.

Do not let the insurance companies take advantage of you. Appeal those claims. Have your medical billing staff set up boilerplate in your word processing software that will work with your practice management software, and merge those documents on each and every claim that is denied or down coded. Pretty soon, the insurance company will realize it cannot take advantage of you and they will adjust their software to see that you are paid correctly and take it from someone else who does not question their authority.




Article Source: http://EzineArticles.com/?expert=Nat_Wynn

If I decide to outsource my medical billing how will I keep track of it?

Many physicians today question whether or not outsourcing their medical billing to a professional medical billing service is the right way to go. These same physicians ask themselves if their medical billing is not in-house how they will really know the true status of their receivables. Prior to making a decision regarding your medical billing, it's imperative to locate a billing service with the necessary experience and with whom you feel comfortable working.

It's also very important to make certain that they provide you monthly reports that accurately reflect exactly what amounts they billed, how much was collected and what amount is still outstanding. Your accounts receivable should be worked on a weekly basis so that is does not go beyond the 90-day mark (there are some cases when the insurance companies take longer than 90 days).

Here are some questions you'll want to be sure to ask a prospective medical billing service:

* Do they post charges on a daily basis?
* Do they transmit claims on a daily basis?
* Do they post payments on a daily basis?
* Do they send out monthly statements to the patients?
* Will they credential any new physicians joining the practice and will they re-credential existing physicians?

I can't stress enough that when you decide to outsource your billing you'll want to be sure to have available a list of questions to ask the medical billing service representative with whom you speak, and insist that your questions are answered accurately and to your satisfaction. Also, don't be afraid to check out billing services outside of your state; the majority of medical billing services utilize the internet, fax machines and electronic claim filing, so it's no longer necessary to practice in the same state in which your medical billing service is located.

The key to making this decision is patience; it's highly recommended that you take your time, whether you're just contemplating outsourcing your medical billing or simply considering changing billing services. Remember, this is your income and what is ultimately best for your practice; both of these factors deserve considerable time and attention. I wish you the best.



Article Source: http://EzineArticles.com/?expert=Mary_Owston

Blame the insurance company is the mantra exclaimed by all, but does it really fit. I know they can give us a fit when trying to collect our money, but they really want to pay the provider, they just want the provider to play by their rules.

I know I will get a lot of grief by saying that they really want to pay the provider, but hear me out. The reason they want to pay is because they want more clients to insure. If they did not pay the providers, the providers as a group would stop seeing their patients, the patients would then not be able to utilize the coverage they are purchasing and would begin to flounder about looking for other coverage. The insurance companies do not want that! Now granted, the insurance company wants to keep as much money as possible, but they know, sooner or later they are going to have to pay the piper! It is a self balancing system that when left alone will right itself each and every time.

This subject came up last week because I was talking to a new provider about his billing. I had previously discussed his billing and he said he wanted to continue for a while with what he was doing. He acknowledged that all of his claims were not being paid and many of the rejections had to do with the billing staff. Sadly, he has now stopped seeing one entire group of patients that are associated with one of the CMOs handling part of the Georgia Medicaid program. This really hurts my heart, because of several reasons, not the least of which is the patient. They are currently locked into that CMO and cannot change, want to see this particular provider, but now are unable to do so. The added pain is that it his medical billing that is at issue and not the insurance company. You see, the billing personnel have convinced him that the insurance company is at fault with why they are not being paid. Nothing could be further from the truth!

My staff handle numerous claims that go through that company and those claims are getting paid. It is not magic, it is good old fashioned hard work of keeping up with what the payer wants, and passing that information through in the form of a claim. Day in and day out they are paid.

Do not allow your staff to point the finger at that unknown faceless giant called the insurance company when the billing staff does not do their job in getting your claims paid. Force them to take an active role in getting each and every claim paid! Do not allow them to get away with sitting back and blaming someone else. Working medical billing is an ongoing learning experience and anyone who is not willing to continue to learn and keep up should be moved out.



Article Source: http://EzineArticles.com/?expert=Nat_Wynn