Why I won't Outsource Medical Billing

• We can’t afford to spend money on extra services.

• It will make billing more complicated.

• We want control of billing and collections.

• Our community needs these jobs.

• I LOVE STRESS!

Medical billing is one of the most crucial components in the healthcare business equation. However, the healthcare industry has created a complex monster...

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The opportunities for mistakes…astronomical

• 250 people may potentially be involved in a single patient's bill 1

• 55% - patient bills containing errors

• 30% - incorrect insurance verifications 2

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Economic Impact of Billing Errors

• $17 billion lost to admin. costs due to errors

• $125 billion lost to poor billing practices 4

• $58 million in improper Medicare CAH outpatient payments

• 92% caused by insufficient/incorrect documentation

• $3.4 billion in improper Medicare hospital outpatient payments

• 95% caused by insufficient/incorrect documentation

• $1.3 billion in improper Medicare inpatient payments 5

• 47% caused by insufficient/incorrect documentation

• 50% caused by medical necessity errors

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Rural Healthcare Facilities in Trouble

• 673 rural hospitals currently vulnerable to closing

• 60+ rural hospitals closed since 2010

• 68% of closed facilities were CAH

• 99,000 healthcare jobs at risk

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Symptoms of a Struggling Facility

• Elevated days in A/R (more than 55 days)

• Denials increasing

• Net collections rate declining

• Claims not received by payers

• Lack of internal business process controls

• Difficulty recruiting and retaining qualified and experienced staff

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Failure to Adapt Critically Impacts Bottom Line

• Decrease in volume

• Demographic shifts

• Changes in payer mix

• Reimbursement reductions

• Deteriorating physician relationships

• Overzealous spending

• Poor financial management

 

Typical (Negative) Solutions

• Downsize through layoffs or attrition

• Reduce the scope of services provided

• Micro-manage employees’ tasks & time

• Make administrative pay cut

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Seven Positive Solutions to Increase Profitability

• Improve the hospital’s reputation through high patient satisfaction. Without a good reputation a hospital will not achieve success financially or otherwise. Its reputation has a fundamental influence on its bottom line.

• Re-think billing and collections. When patients don't clearly understand their financial responsibilities they are less likely to pay on time (or at all).

• Focus on communication strategies. Communication is a crucial link between your clinical efficiency and a patient’s experience.

• Increase patient satisfaction by providing high quality customer service.

• Focus on limiting readmission regulatory penalties.

• Reduce unnecessary testing whenever possible.

• Get a complete understanding of your revenue cycle performance