The current outlook for healthcare reimbursement is commonly regarded as tricky. These days, insurance companies and other payers follow an increasingly complex system, which confuses providers through convoluted rules, processes, etc. The obstacles they are served in the process include denials, underpayments, and misplaced or ignored claims.
For doctors, it has gotten harder to get paid for the work they do, and most medical practices have already given up on collecting all they have earned.
The Numbers From CMS
- 70% of claims are paid on the first submission
- 30% of claims either are denied (20%), or get lost or ignored (10%)
- 60% of denied, lost, or ignored claims are never resubmitted
- 18% of claims are not collected
Medical Group Management Association (MGMA) research estimates show that practices get underpaid by payers in the U.S., by as much as 7% – 11%. Throw in a 7% underpayment to the 18% or claims that do not get paid, with medical practices failing to collect at least a fourth of the money they earn by treating patients. This adds up to around $125 billion every year.
Reclaiming Funds The First Time
Whenever a claim gets rejected the first time after submission, it becomes highly unlikely that the practice will ever be compensated for that work. It is highly advisable practice to improve catch potential denials before claim submission. Software can also be helpful for practices looking to manage this, using a solid rules engine to identify claims that carry likelihood of being denied.
Getting Paid In Full
One of the problem keeping medical practices from collecting the full amount they earn, is payer underpayments. Practices are reimbursed differently for the same procedure, because of the individual contracts that the doctor can get from each payer. Keeping track of each payer contract manually is hard, and it is just as hard to figure out if the practice is being underpaid.
It is vital for your medical practice to be able to sift through data regarding billing and collection trends so that you can figure out how to improve the practice. An intuitive software system lets practices set up the creation of reports for continued analysis, and generate custom reports while on the move, when the need arises for specific information.