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Collecting Insurance Reimbursements

Benefits of Outsourcing Electronic Claims Processing

  • The Problem: Doctors Have A Hard Time Collecting Insurance Reimbursements
    Most people are aware a large percentage of most doctors' revenue comes from insurance reimbursements. But many people don't realize the process of filing insurance claims is cumbersome, time consuming, and energy-draining for the doctor.
  • The insurance companies have made it as difficult as possible to get paid; they obviously have a vested interest in paying out as little money as they possibly can. One of the best ways they've found to hang on to their money a little longer is to have created an extremely difficult set of hoops doctors have to jump through to file and collect their insurance claims.
    The energy-draining process of filing insurance claims is very expensive for a doctor’s office to perform. First, they have to spend time filling out a standard insurance form called a CMS-1500. This chore can take up many hours in a day if the doctor has many patients.
  • Then, if there's any minute detail on that paperwork that is not filled out correctly, the insurance company rejects the entire claim and sends it back to the doctor--unpaid. The doctor's staff then has to figure out what the problem is, attempt to fix it, and then re-submit it and hope they've gotten it right the second time around.

    The results of this frustrating process are startling: Many of these claims are rejected, many of them are lost in the shuffle and NEVER collected, and the time it takes the doctors to collect their money can be 45 to 90 days. It can be even longer for Medicare and Medicaid claims.

    Then, besides stretching the time it takes to receive payment, this process also presents doctors with another major problem: It takes a tremendous amount of employee and overhead cost for them to play this frustrating claims- filing game.
  • In fact, the New England Journal of Medicine (Volume 349:768-775) says physicians' administrative work and costs amount to 26.9 percent of physicians' gross income. That translates into an average of about one and a half clerical workers per doctor at an average cost of $51,564...not including hidden costs like vacation time, insurance, and the like.

The Solution: Electronic Medical Claims Filing

  • That's where electronic medical claims filing comes into play. Most doctors rely on their staff to laboriously file claims, guide them through the approval and collection process, and then wait weeks before seeing a penny of the money.
  • Now doctors can outsource the entire process to a medical billing professional. As trained professionals, we are equipped with a proprietary, state-of-the-art system that will allowing us to electronically file claims for doctors online, in real time. The benefits to the doctor are enormous.

    Benefit #1: FASTER…Much Faster: Electronic filing drastically reduces the amount of time it takes to collect from the insurance companies. Instead of taking weeks, it takes just 7 to 21 days.

    This is possible because electronically filed claims are handled by computers and therefore bypass all of the low-wage, untrained human "gate keepers" working the low-level clerical jobs for insurance companies.
  • These "gate keepers" are the ones who ultimately determine whether or not and how fast doctors should be paid. But when handled by computers, there is no "humna interference" to bog down the process.

    Benefit #2: LOWER Rejection Rate (By Far): The rejection rate for claims plummets from 30% to under 2%. Obviously, claims that aren't rejected move through the system a lot faster. Plus, claims that are mysteriously "LOST" by the insurance companies, and never paid, are eliminated altogether. They can't be lost when using Electronic Medical Claims Filing because they produce an acceptance report from the carrier ensuring receipt.

    Benefit #3: FREES The Doctor's Time: Many doctors spend as many as one and a half to two hours a day supervising and working on insurance claims. Or at the very least, they have a high-paid staff person working on them.
  • When the doctor outsources the Electronic Medical Claims Filing to us, his or her time is freed up to either see more patients…and therefore make more money... or else spend more time doing other things. Outsourcing Electronic Medical Claims Filing also frees up the time of the doctor’s staff allowing them to make patient calls and run the office more effectively instead of worrying about medical claims all the time.

    Benefit #4: IMMEDIATE Cost Savings: The doctor will realize a real and immediate cost savings when they outsource the billing to us. A recent survey in the Medical Group Management Journal showed the average cost of internal billing departments at 11% of the practice’s income.
  • Our outsourced billing services, on the other hand, only charge $3.00 to $5.00 per claim to perform the same service, depending on the volume and complexity of the situation. That's usually only a small percentage of the practice's income. And that's just the savings on the front-end direct cost of collections. That doesn't take into account the increased effectiveness and efficiencies of actually collecting the money listed above.


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