10 Things Your Medical Biller Won’t Tell You

Medical billing: is the back bone of your medical practice. Lets skip the filler and dive right into the 10 things your medical biller won’t tell you.

1. 50% of denied claims are never resubmitted.

WHAT? COME AGAIN? Yes, it’s true. According to an AMA statistic, 50% of denied claims are never corrected and resubmitted.

Here’s why:

  • Not cost effective for your biller to spend more man hours on a claim that will not fall into a profit margin if/when it is finally paid. This is one of the many ramifications of seeking the lowest bidding medical biller in terms of commission rate.
  • Medical billers don’t have the resources to correct a claim. Again, opting for the lowest bidding commission rate comes with a big price. If your medical biller is charging you 3%, know that corners must be cut in their operations in order to meet a profit threshold. The billing platform may be one of those corners. A top billing software will have many options for your biller to access the proper documentation to resubmit a denied claim with the requested information.
  • Insufficient resources to follow up on insurance carriers.

A medical billing company that is too big can easily over look your account, and a smaller company may not have the resources to maximize your profits. The sweet spot in finding the right medical biller is in the middle. Not too big, not too small.

2. 30% of your claims are denied when billed the first time.

According to the same AMA study, 30% of your claims are denied for these simple reasons:

  • Misspelled patient name
  • Incorrect or missing patient DOB
  • Eligibility
  • Authorization
  • Insurance order
  • Insurance pre-fix
  • Referral (NPI)
  • Incorrect Facility on claim
  • Inconsistent diagnosis
  • Deactivated Procedures

Almost all of these reasons could have been avoided if ELIGIBILITY WAS VERIFIED! Verifying eligibility not only ensures that your patient is an active member of the insurance program; it also tells your biller/office staff where to send the claim. Doing this will shrink your denial percentages.

3. Easy money is all they care about.

After the insurance (maybe) paid your claim, and the patient portion is applied, three statements are sent to the patient for payment, and that is the end of it. Regardless if your patient pays or not, the bare minimum is often the standard. What could be done differently? Your billing provider should be making out-bound phone calls to your patients regarding a  payment. Statistics show that patients are twice as likely to pay a balance when called on the phone in combination with paper statements. Check your patient A/R or Patient Write-offs to see how much you’re not collecting from your patients.

4. You shouldn’t sign yearly contracts with medical billers.

Never get locked into a contract with a billing company. You’re not going anywhere for at least three years. However, they could terminate the agreement for a *fee*. Your billing contract should be open ended. Your business should be earned every month.

5. The doctor is wrong.

There is no sugar coating this one. Not knowing what we don’t know will lead us into a quagmire, so sometimes it’s a good idea to let those who know take the wheel. But, if letting go and trusting your billing company is a problem, maybe its time to find the company that will take anxiety out of billing.

6. The doctor’s office staff does not cooperate.

It feels good to finally get that off my chest. It’s true. There is a lot of resistance from the office staff, especially if we find inconsistencies in a protocol and try to correct it. While we understand that the front desk may have resistance to learning new methods due to their lack of time to complete their current tasks, the end result will be efficiency and smoother workflow.

7. Medical billers don’t bother to challenge payments.

This hurts reimbursements. If your biller doesn’t challenge payments based on your contract agreements, you could be shorted a hefty percentage of your contracted rate. Also, make sure that your fee schedule is up to date. It could be possible that the insurance carrier pays 100% of a claim, only because the fee schedule is set lower than the maximum allowed rate.

8. Medical billers skip out on top dollar software.

There are things that should never be penny pinched. Number one on the list is your medical billing platform and EHR. Are there cheaper platforms out there? Yes. Will they be as effective in streamlining and maximizing revenue? You’d spend more money in finding out than you’d save.

9. Your billing agreement could be sold to another billing company.

Your medical billing contract could be sold to a separate billing service without your consent- LEGALLY! This is why we urge physicians not to sign yearly contracts.

Also, your contract could be sold as part of a franchise where the billing office will be used as a clearing house.

Do your research and look into the medical billing companies DBA or LLC information to determine the age of the establishment. A seasoned billing company isn’t likely to stay open for more than a few years when conducting business with deceptive tactics.

10. Your patients aren’t treated with respect

Nothing will hurt your practice more than the mistreatment of your patients. Your third party vendors are an extension of your practice, and you medical billing and practice management service MUST treat your patients with respect.

With the availability of social media and linking literally every business with a review, one upset patient could leave lasting ripples in a negative experience  and review of your practice. It is crucial that your billing and practice Management Company take that extra step in cordiality.

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Certified Healthcare Network is a medical billing and practice management service that is dedicated to medical providers and maximizing their reimbursements & office work flow.

We are dedicated to maximizing our clients reimbursements and decreasing workloads.

For more information on how CHN can boost your bottom line, please contact us at Connect@chnbilling.com or call us at (888) 504-5114

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