One of the top challenges faced this year by most physicians is getting properly reimbursed for their medical services, according to recent survey results by MedCentral.
Listed below are five top factors from the 2024 Annual MedCentral Survey that physicians say are “very” or “somewhat” significant challenges facing their practices today:
Key Factors That Challenge Physician Practices
Administrative work: 66%
Reimbursement issues: 57%
Staffing shortages: 56%
Staff turnover: 50%
EHR reporting burdens: 50%
Financial stability remains a top concern for physicians as they juggle staffing shortages and regulatory changes, while working hard to optimize reimbursement for their services. The path to full reimbursement is layered with complexities, leaving many physicians struggling to collect what they’re rightfully owed.
This article will outline the key reasons physicians struggle to secure optimal reimbursement and offer solutions to navigate the opportunities.
Why Medical Practices Struggle to Optimize Reimbursement
Several factors contribute to the ongoing challenge of maximizing reimbursement for medical services. Here are a few of the most prominent:
Complex Coding and Billing Rules
It’s difficult for practices to hire and maintain a qualified revenue capture team with a deep understanding in medical coding and billing, and Healthcare Common Procedure Coding System (HCPCS) codes, Current Procedural Terminology (CPT®) codes, and International Classification of Diseases (ICD-10) codes. Staying abreast of constant updates and ensuring accurate application of these codes is not an option, and can be a significant burden for many practices. Errors in coding can lead to denials or underpayments.
Ever-Changing Regulatory Environment
Regulatory guidelines governing reimbursement are constantly evolving, particularly with Medicare and Medicaid programs. Keeping track of these changes is a continuous requirement and sometimes a battle. Practices that fail to adapt to these updates risk significant revenue loss due to rejected claims.
Denials and Appeals
Unfortunately, claim denials are a common occurrence for some medical practices, resulting in lost revenue. Navigating the complex appeals process to overturn denied claims requires expertise and time, resources often scarce in busy practices.
Time Constraints
The administrative burden of managing medical billing and patient collections often leaves physicians with less time to focus on patient care. Juggling clinical duties while ensuring the billing team adheres to best billing practices is hard to prioritize. Even small practices need to have top-notch business executives who are experts in revenue cycle management (RCM) and practice analytics.
Limited Resources
Smaller practices may lack the dedicated staff and technology infrastructure necessary for efficient RCM operations. This can lead to medical coding errors, missed claims, and ultimately, lost revenue.
The Path to Optimal Reimbursement: Solutions for Physicians
While the challenges are substantial, a proactive approach can help physicians optimize their reimbursement rates. Here are some key strategies:
Invest in RCM Technology:
- Electronic Health Records (EHRs): Utilize up-to-date EHR systems with built-in coding and billing features to streamline the process and reduce errors.
- Practice Management Software: Implement software that automates appointment scheduling, insurance verification, and claim submission, saving time and resources.
- Specialized RCM Software: Consider dedicated RCM platforms that offer advanced features like automated coding, claim scrubbing, and real-time eligibility verification.
Stay Informed:
- Join Professional Organizations: Participate in industry associations like the Medical Group Management Association (MGMA) to stay updated on the latest regulatory changes and best practices.
- Subscribe to Newsletters: Sign up for newsletters from CMS and other relevant agencies to receive timely information about coding updates, reimbursement policies, and industry trends.
- Attend Industry Conferences: Participate in conferences and webinars to network with other healthcare professionals and learn about emerging technologies and strategies.
Focus on Accurate Coding:
- Train Staff: Provide comprehensive and ongoing coding training to your staff, covering CPT®, HCPCS, and ICD-10 codes, as well as the latest coding guidelines and regulations. Ensure coders are AHIMA or AAPC certified.
- Cross-Validate Codes: Implement a system where two coders independently review and verify each other’s work to minimize errors.
- Implement Coding Audits: Perform audits monthly to uncover new patterns of errors and implement prevention tactics to stop errors from repeating.
- Use Coding Software: Utilize coding software tools that can assist with code selection, validation, and documentation.
Develop a Robust Denial Management Strategy:
- Track Denials: Implement a system to track denied claims, analyze the reasons for denials, and identify patterns or trends.
- Educate Staff: Train your staff on common denial reasons and how to address them effectively.
- Develop Appeal Templates: Create standardized appeal templates for common denial scenarios to expedite the appeals process.
- Negotiate with Payers: If necessary, negotiate with payers to resolve denials and secure appropriate reimbursement.
Consider Outsourcing RCM Services:
- Assess Your Needs: Evaluate your resources and RCM expertise, as well as opportunities to recover additional revenue by outsourcing RCM services.
- Choose a Reputable Provider: Select an RCM service provider with a proven track record and expertise in your specific medical specialty.
- Clearly Define Scope of Services: Establish a clear scope of services to ensure the RCM provider meets your practice’s specific needs and expectations.
How UnisLink Can Help You Optimize Reimbursement
UnisLink is a leading provider of RCM services, committed to helping independent medical practices maximize their reimbursement rates. Here’s how we can be your partner in navigating the complexities of medical billing:
Experienced Team: Our team of certified medical coders and RCM specialists ensures accurate coding, claim scrubbing for errors, and streamlined claim submission processes.
Cutting-Edge Technology: We utilize advanced medical billing services technology that automates repetitive tasks, minimizes errors, and tracks the progress of claims in real-time.
Denial Management Expertise: Our RCM team proactively identifies and analyzes denied claims, developing compelling appeals strategies to improve your success rate.
RCM Data Analytics: Analytics dashboards allow practices to easily keep track of performance indicators and gain better insight into areas requiring more focus for optimal financial performance.
Dedicated Support: We provide ongoing support and guidance, keeping you informed about regulatory changes and best practices for maximizing reimbursement.
With UnisLInk, physicians can navigate the complexities of medical billing and collections, maximize their revenue, and ensure the financial sustainability of their practices.
By alleviating the burden of medical billing and collections, UnisLink allows physicians to dedicate more time to patient care, leading to improved patient satisfaction and overall practice efficiency.
Request a quote today and get a free revenue opportunity assessment showing you how much more revenue you can earn by partnering with UnisLink.