As a doctor, billing should have been the least of your worries. After all, it’s not part of your job description. The reality, however, is it is. It might even be one of the most significant barriers to optimal work performance.
The Problem with Billing and Reimbursement
For many years, a lot of patients no longer rely on their spending on healthcare. Instead, they turn to their health insurance plans, including Medicare. This also somehow streamlines the process.
For example, if a person gets sick, they don’t need to wait until they have the funds to visit a doctor. They can schedule an appointment, walk in, and walk out, letting their insurance coverage take care of the bill.
Then the doctor’s clinic or team processes the payments and collections. And this is where the challenges lie. No doubt, physicians should be able to maximize practice reimbursement. How else can they continue to operate and provide excellent services to their patients?
A number of them, however, feel that the reimbursement process is more of a risk than a benefit. In a survey by Carl Marks Advisors, nearly 75% of the healthcare workers considered reimbursement as their primary challenge. It can take weeks or even months before doctors receive their payments. It could be because of the following reasons:
1. Staff Shortage – About 56% of those who answered the Carl Marks Advisory survey considered staffing shortage as a chronic problem. The United States would need more than 115,000 doctors by 2030 alone. Now, consider the number of bill coders, nurses, and other healthcare professionals to fill in.
2. Technology – More types of technologies are available for healthcare facilities, particularly clinics. These should allow them to streamline their collection process, keep track of their financial performance, and find ways to improve revenue cycles. But over 75% of healthcare workers find them either expensive or complicated, according to the survey.
3. Insurance Claim Denial – On average, insurance companies are more likely to deny or reject at least 5% of the total claims. At its worst, it can reach up to 10%. It might not seem a lot until you do the math. Insurance providers can deny a claim for a variety of reasons, such as the service is not part of the patient’s plan.
4. Medical Billing Errors – These mistakes are more common than people think. At least 30% of the billing schedules will contain errors. It is rampant enough to grow a niche business. Some companies now help patients spot these mistakes to pay less on their healthcare.
The effects of reimbursement issues are significant. For example, doctors are more likely to see their patients for a shorter period. The average appointment now lasts only 15 minutes. It might not be enough for them to provide comprehensive medical care. The need to increase their number of patients might also lead to a more extended waiting period.
The solution is complex and demands changes in many sectors from the hospital to the insurance provider. What’s important, though, is there are ways to improve it.
