What is the definition of a successful doctor?
It depends on each person's point of view.
Some may say doctor skills and knowledge.
Some may add kindness and empathy.
Some may also add compassion.
All the above is true, BUT we live in the material world and a medical professional
has to have an office to see the patients, qualified assistants, up to date equipment and supplies. This is why it is so important to ensure that doctors are properly paid for the services.
Most people in the United States have health insurance, and doctors must deal with insurance companies. Medical billing is a difficult process, which is where billing companies come in. Medical billing is an essential component of today's healthcare system. Allow professionals to submit and track claims for payment for services rendered by a healthcare provider. Not only does it ensure that medical providers are paid for their services, but it also ensures that patients are correctly billed and charged for the services they receive. Several steps are involved in this complex process. The first step is to gather all of the required information from the patient. This includes a patient's insurance details, medical history, and any other relevant facts. After gathering the needed data, the medical provider will prepare a medical claim form and submit it to the insurance company. There are numerous points during this process that may result in a claim denial.
How Common Are Medical Claim Denials?
Medical practices should strive for a 95% clean claims rate. However, few medical practices reach that optimal goal. Most practices receive reimbursements for the first time a claim is submitted for somewhere between 75% and 85% of claims they bill.
The 5 Most Common Types of Medical Claim Denials:
- Eligibility issues.
- Missing or invalid claims data.
- Authorization issues.
- Non-covered services.
- Missing documentation.
Data was reported by insurers for the 2021 plan year and posted in a public use file in October 2022. We find that, across HealthCare.gov insurers with complete data, nearly 17% of in-network claims were denied in 2021. Insurer denial rates varied widely around this average, ranging from 2% to 49%.
Assumption:
Calculation for every $1000 claimed.
WCH 6% | Competitors 3% | Competitors 5% |
Reimbursement rate 98% Total $980 with reimbursement rate 98% Billing fee: 6% $58.80 Calculation: 980 – 58.80 = 921.20 | Reimbursement rate 87% Total $870 with reimbursement rate 87% Billing fee: 3% Payment to billing company $26.10 Calculation: 870 – 26.10 = 843.90 | Reimbursement rate 87% Total $870 with reimbursement rate 87% Billing fee: 5% Payment to billing company $43.50 Calculation: 870 – 43.50 = 826.50 |
Total gross income is $921.20 | Total gross income is $843.90 | Total gross income is $826.50 |
Reimbursement rate 98% Total $980 with reimbursement rate 98% Billing fee: 6% $58.80 Calculation: 980 – 58.80 = 921.20 | Reimbursement rate 90% Total $900 with reimbursement rate 90% Billing fee: 3% Payment to billing company $27 Calculation: 900 – 27 = 873 | Reimbursement rate 90% Total $900 with reimbursement rate 90% Billing fee: 5% Payment to billing company $45 Calculation: 900 – 45 = 855.00 |
Total gross income is $921.20 | Total gross income is $873.0 | Total gross income is $855.00 |
WCH SB helps to optimize profits, improve collections (we excel here), accelerate cash flow, reduce administrative costs, and minimize medical billing denials. We provide correct and accurate coding because an incorrect code can result in a denied claim. Claims are submitted to insurance companies for their review and reimbursement. In the event of a claim denial, we are responsible for revising the claim and resubmitting it. We will also manage appeals due to a variety of denial reasons and manage collections from the insurance companies and/or the patients who received services.
