Medical practice reimbursement 

Medical practice reimbursement has always been a major pain point in the health care industry. It is difficult for several reasons:

• Inconsistent collection of patient co-pays
• Delayed or missed payments
• Increased number of rejected insurance claims
• Inefficient or nonexistent period closing process

The presence of one or all these problems negatively impacts the practice.  The revenue you lose from failing to maximize your reimbursements quickly adds up. Implementing a well-designed system protects your practice from financial problems & loss of revenue.

Creating a good reimbursement process for your medical practice entails five major factors:

1. Registration and Time-of-Service Collections
Well-trained front office staff with the right tools and systems can improve your operations. Once they've verified patients' eligibility, they can determine the appropriate coverage. Then they can work with the patient and insurance companies to determine payments and collections.

2. Charge Capture and Claim Submission
Using technological solutions helps you streamline your operations. A charge capture system records your procedures for comprehensive documentation. This, in turn, optimizes your claim submissions process.

3. Denial Management and Payment Processing
Denial of claims is not uncommon. Insurance companies do it because some procedures aren't covered by their plans. Having a good denial management system enhances your revenue cycle. It also accelerates payment processes because it rids you of the constant back-and-forth with insurance companies.

4. Patient A/R and Collections
You accounts receivable (A/R) follow-up process ensures you complete collections on time. Collecting the largest patient balances will have the greatest impact on revenue.

5. Reporting
Documenting your processes and publishing reports out of the collected data allows you to analyze your practice’s overall performance. Comparing this information with industry KPIs identifies areas of improvement.  This process helps you establish the necessary changes to improve your practice. 

Maximizing Your Medical Practice Reimbursement

Patient financial responsibility is a regular part of any practice and comes with a number of potential issues. Most medical practices are equipped to handle reimbursements from insurance companies. However, many still struggle with self-pay medical practice reimbursements.

Be transparent
Issuing bills months after a patient’s visit makes collection more difficult. Patients are prone to forgetting details about their visit and may be more likely to question charges. Informing patients of their costs up front makes everything much easier.  It’s a good idea to encourage payment at the time of visit as much as possible.

Go paperless
Choosing to go paperless gives your medical practice several benefits. One of these is eliminating payment barriers. Send bill statements via email or text message to accelerate the process and adopt an online system to receive payments.

Reduce A/R
Although improving A/R practices helps cut down on lost revenue, there are other ways to further optimize the reimbursement process. Understanding the latest industry benchmarks and adopting solutions that integrate these will reduce your need for A/R.

• Keep denials under 5%
• A/R should be under 40 days
• A/R over 120 days old should be less than 12%