Small and independent providers have faced an unprecedented number of challenges today – from the move away from fee-for-service payment models to merit-based payment to new certification requirements to growing pains in adopting new technologies.
Medical billing companies are working on the frontlines of some of these issues on behalf of practices and get a first-hand look at the major headaches facing providers today. We recently asked for their observations; here’s what they shared:
What are some of the major challenges facing providers today?
“The challenges of denial management have multiplied. ICD-10 and value-based reimbursement will have huge impacts on claims processing. Providers must be proactive on dealing with the constant change imposed by outside forces.
Unfortunately, many organizations get mired down by ineffective systems and disconnected personnel who do not have up-to-date denial management resources. We provide answers, solutions and assistance so that a healthcare organization can meet these challenges.”
– Tammy Tipton is President of Appeal Solutions Inc. and the co-author of Power of Appeals Denial Management System. She is also the author of Turning Insurance Denials Into Dollars, a popular denial management manual for both hospital and physicians. She has written extensively on the topic of medical receivables and has frequently lectured on conducting successful appeals and using today’s complex legal system to protect healthcare claim assets. Her company, Appeal Solutions, provides medical claim recovery consulting to hospitals, physicians and billing companies.
“ICD-10 Implementation. Meaningful Use. Pay-for-Performance, etc.
With all of the administrative burdens placed on physicians by the Affordable Care Act, coupled with the fact that they are seeing so many patients per day – proper contract management is getting lost in the shuffle.
Managed care contracting is an integral part of medicine for virtually all health care providers.
Not managing or accepting bad contracts will have a severe negative impact on physician and group practice revenues.”
– Dana R. Bellefountaine Jr., president and CEO of CodeToolz, is a senior C-level executive with over 20 years of experience in Healthcare Finance and Accounting with medical practices ranging from single-physician startups to multi-physician, multi-specialty facilities. He has a considerable background in reimbursement methodologies and financial analysis and understands the current and emerging challenges that face the healthcare providers and partners with clients to address these issues and create opportunities.
“As the reimbursement amounts for out-of-network are usually much higher than in-network (sometimes the difference between $6,000 and $40,000), insurance carriers make them much more difficult to collect. There are a variety of unpublished and unknown internal edits, third-party contractors and double-sided red tape that has to be navigated.”
– Matt Dallmann is a Co-Founder of New York City’s VGA Billing Services, and specializes in out-of-network medical billing.
“A national trend has hospital and medical corporations buying up small independent practices and as a result, creating pressure on the solo and small practice. Providers are facing the choice of continuing to evolve their current practice and patient relationships or join a large group where everything from length of patient encounters to billing practices are dictated by the group.”
– Bob Liepman owns Documed Medical Billing Services, which manages the entire revenue cycle for clients in the medical and behavioral health professions.
If you’re a small practice looking for affordable and effective help with medical billing, visit PracticeSuite to compare plans and pricing.