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Medical Billing Services for Automated Denied Claims Recovery

With the ongoing transition of value-based care, medical healthcare providers have seen an increase in claims denials, and many medical practitioners are now looking for innovative solutions for proficiently managing value-based care and fee-for-service claims. This is nothing new in the trajectory of medical billing services.

Unfortunately, according to a recent analytics survey from HIMSS, over one-third of medical practitioners still need to start using a manual process for managing claim denials.

Medical Billing Services

Considering the blatant complexities around claims submissions and the labor associated with managing claims denials, it was a surprise that more organizations still need to automate their denial management processes via outsourcing medical billing services

The definitive move to value-based care and alternative payment models will take time. That is until these models are rigorously tested and then implemented. Until then, medical practitioners still have to focus on the current processes, while automating denial management processing can, in a way, significantly improve collection efforts.

Advantages Claims Process Automation

Medical practitioners who like to stay profitable while meeting future challenges shall consider moving towards automation – which in turn offers plenty of benefits. As a starting point, automating the claims denial process means eradicating the time-consuming paper-based processes. Doing so decreases the time spent on the tasks and boosts the accuracy of data/information while streamlining maintenance and data retrieval. All of this, in addition to increasing productivity while cutting down on costs.

Below are some of the primary advantages of an automated claims process/system:

  1. Time saved from the automation of claims can be better spent on the patients, ensuring they receive the best care.
  2. The automation software is designed to perform automatic pre-audits to find errors before the claims are submitted to a payer. Less number of errors means lower claims denials.
  3. The medical claims can be directly submitted to payers instantly
  4. Massive reduction in costs for supplies, postage, and mailing expenses
  5. Medical practitioners can now track a claim’s progress between the intermediaries and a payer via an audit trail
  6. Receive confirmations that a payer has received claims via reporting features
  7. Accelerate the process as a whole, along with the turnaround, with the payment timeframe
  8. Boost your medical practice accounts receivables

Automation & ICD-10 Challenges

With the adaptation of ICD-10 regulations, the CMS and its contractors shall need the correct diagnostic codes to be submitted for the medical providers to be reimbursed.

What does it mean in layman’s terms?

It means that the medical providers will no longer be able to use codes such as “NOS” or “Unspecified” or the “not otherwise specified.” If medical providers continue to do so, they shall face scrutiny from the CMS and slower payments, which might lead to revenue loss.

So, collectively there are two options here:

  1. Billers and physicians can assume they have memorized all correct codes and submit claims while hoping for the best, or
  2. Work to automate their billing process via medical billing services while leveraging technology to discover errors before submission.

Automated Billing Software

Medical practices seeking medical billing software must take several considerations into account. While it is entirely possible to have your EHR solutions and billing come from two different vendors, given the solutions can be interfaced and work nicely with one another. Plus, it is also often easy to purchase two technologies from the same company, such as Physicians Revenue Group, Inc.

Another issue that is important to be taken into account is the number of vendors offering support during and after the implementation. Does the company/entity charge a fee for system upgrades, hosting, and service calls?

If it is the case, then be advised that these add-on costs do add up quickly and might turn into a bill that a medical practice cannot afford. This is why it is essential to know all the costing plans upfront, so you can determine and analyze if the solution offered is affordable for your practice.

Another significant consideration is gauging how proficient the technology is in supporting the practice’s goals in terms of continuing healthcare reforms and internal growth of the medical practice.

Does the offered solution manage the ICD-10, 11, and 12 down the road?

Can it handle the meaningful usage of requirements and participate in the newer value-based payment models?

For being worth the investment, the EHR/billing systems should be able to help the practice manage patients while simultaneously keeping pace with the industry changes.


Is Automation for You?

Indeed, Physicians Revenue Group offers holistic medical billing services that facilitate an end-to-end revenue cycle management solution for over 40+ specialties. Our state-of-the-art medical billing servicesmedical billing audit services, and revenue cycle management solutions will help boost your revenue by getting your practice reimbursed faster and more often without a hitch.

Regardless of your medical practice’s location or size, Physicians Revenue Group, Inc. facilitates the transition making it cost-effective, simple, and a painless experience. 

At PRG, we handle the entire setup, documentation, process coordination, and whatnot with no additional costs. Plus, there are no upfront setup costs; you only have to pay us for the dollars we collect for your practice.

If you, as a medical practitioner, are tired of the hassles of denied claims and the overall medical billing process – get in touch with us today.