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CFO Trapped in Bookkeeper Software Claims Rejection by Biller

As a medical billing service, it’s hard to soar with the eagles when your billing software is a turkey.

  • Turkey software is the kind that gobbles up all your time, keeps you pecking around in data entry, and offers no way to help your clients stuff the financial holes so common in manual processes.
  • In other words, you can’t offer Revenue Cycle Management services to your client when all you have is the limited functionality of a desktop medical billing program.
  • Now, regardless of the size or type of practice, all physicians have two things in common. They want to focus on treating patients, and they want to keep more of the money they earn. It’s about patients, not paperwork.

The MGMA reports that as much as 40 cents of each dollar that a practice brings in is spent on administration. Physicians recognize that coding and financial administration is not their forte, so they hire experts to handle the time consuming and problematic task of insurance billing is a no-brainer.

In contrast, an end-to-end medical office software with integrated EMR and Practice Management allows a medical billing company to go far beyond data entry and claim management, it enables them to:

  1.  Function as an internal billing department
  2. Act more as a financial advisor, or CFO.

One way medical billers hamstring their efforts is that their current processes keep them on a hamster wheel, dealing with billing crises while managing kludgy operations that involve manual data entry and stressful calls to practices requesting source material, then re-keying the data over again. Even large medical billing companies with expert billers and strong management spend large chunks of time on tasks that should be automated within software.

For example, a sophisticated integrated system will allow a physician’s staff to quickly and easily check patient eligibility. If eligibility is not checked, the software can instantly alert the front office and notify the billing company, so that there are now checks and balances along with new process automation.

On the back end, claim follow-ups are more thorough. Instead of “Oh, yeah, whatever happened to that claim for Mary Smith?” billing managers can preset alerts. If an insurer does not respond to a claim within 10 days, it is automatically queued for follow-up and pushed to someone’s work dashboard. And there’s no hunting for the information needed for follow up—it’s there at the staffer’s fingertips and can be immediately acted on.

With mundane tasks automated and streamlined, imagine how medical billing companies can evolve into trusted practice consultants. Freed from their bookkeeping tasks—and armed with data—they can work with physicians and practice managers to eliminate much of the $700 billion in administrative waste that US practices see each year. Eliminating the large administrative cost is not as easy but doable by focusing rather on single-payer systems and administrative simplification. By moving from a desktop/server medical billing software to a cloud based end-to-end solution, medical billing companies can have their finger on the pulse of a practice’s key revenue drivers, examine and improve every moving part that could compromise practice revenue, including:

  1. Patient benefit verification
  2. Co-pay collection
  3. Timely filing
  4. Superbill tracking
  5. Contract management
  6. Denial management
  7. Underpayments (all payments compared to RVUs and contracted rates)
  8. Collection and recovery management
  9. Employee theft

Last but definitely not least, an end-to-end practice system gives billers instant access to clinical notes, so they can use their expertise to ensure that every patient’s claim is coded to the highest level of specificity with no fear of upcoding, which is cited to be a fear of 70% of physicians and a significant loss of practice revenue.

So, it’s time to step back and see the forest from the trees. Get rid of your turkey software that keeps your wings clipped in manual processing, and start soaring with the eagles with a unified practice management system that offers true revenue cycle management intelligence and advanced practice automation that not only gives your client increased transparency, but a better bottom line to boot.

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