The Right Prescription For Healthcare Is Better Medical Billing

Well designed medical billing processes will play a critical role in driving down healthcare costs. This article discusses this link and the role medical billing services can play in helping make healthcare more affordable.

Although the issue of claims processing is mentioned as one of the sources of rising healthcare costs, the true economic drivers that are keeping the current inefficient and opaque processes in place has not been well explored. The fact of the matter is that the current process prey's upon the technology, process and staffing limitations of most physician offices to take money from the physicians and give it to the payers. The result is rising costs and following revenues for the average medical provider.

Payers consistently and systematically underpay claims. In addition, claims that have been properly submitted and for which proof exists the claim was accepted are simply "lost" by payers and the claims have to be resubmitted (sometimes multiple times) in order to secure payment. I know from experience with many practices that this "lost" claim phenomena is rampant across payers and states.

There is a strong economic motivation for payers to maintain the current inefficient billing process. They can increase their profits sharply since more than fifty percent of the claims they misplace or accidently underpay are never noticed by medical providers.

The payers ultimately lose money on providers that catch the payer's mistakes and pursue the claim. It cost the payers about $25 each time one of these watchful provider's medical billing specialist calls the payer and speaks to a live person. To mange this cost, they payers have a system in place to make sure they pay the diligent practices properly while continuing to lose claims and underpay less watchful practices. They payers do this by grading each practice. If you are watchful you receive an A. If you are not catching the payer's errors you receive a F. A's are paid well. F's are not paid well.

If payers had a base of providers that were all diligent and spotted each and every lost or underpaid claim they would quickly discover that there was no economic incentive to play games with how the claims are paid. This is why better medical billing is a key front in the battle against rising healthcare costs.

If the medical practices and medical billing services dig in and fight for the last dollar on every claim they will quickly force the insurance payers to adjust their internal processes. With each claim paying in full and their staff inundated with billing specialist asking why a claim was lost or underpaid, the payers will see rapidly shrinking profits that will force them to acknowledge that the costs of the games they play are no longer justified by the savings form unpaid claims.

Many companies and individuals are dreaming of the day when the medical billing process disappears entirely and claims are adjudicated in real-time while the patient is standing at the checkout desk. In this system significant costs will be saved, but the system will never emerge until payers no longer have an incentive to play games with medical claims. Medical billing companies and medical providers can make this happen by insuring that all providers are rated A in the eyes of each payer.

Copyright 2008 by Carl Mays II

Carl Mays is the CEO and Chairman of ClaimCare medical billing services and is an authority on medical billing and medical billing companies.

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