Medical billing services exist today to help with the management of medical practices. These services relieve medical professionals of tedious detail work, but rarely do they offer a means to substantially maximize the practice’s bottom line. Physicians1st Billing and Claims is a service that will allow office staff to focus on more important tasks and maximize the return from their insurance carriers.
According to national statistics, only 70% of insurance claims that were initially submitted on paper are ever paid. The percentage of claims that are paid to insurance carriers can be increased by using electronic submissions, such as Physicians 1st Billing and Claims.
Additional statistics suggest that the current cost for a medical clinic to process insurance claims on patients is between $8.00-$10.00. Physicians 1st Billing and Claims can reduce these costs by 50 percent or more.
Statistics show that paper claims turnaround times can take up to 30-60 days, or even 90 days, which creates serious outstanding receivables. Physicians 1st Billing and Claims is able to have money in the doctor’s hands within 14-18 working days by electronically submitting claims. This will reduce outstanding receivables in proportion and significantly improve cash flow.
Statistics also indicate a 30% rate of rejection or suspension for paper claims. This does not necessarily mean that claims are never paid. It does however mean that medical staff have to deal with insurance companies over payment. With the extensive editing performed on electronic claims prior to their transmission to carriers, this percentage is reduced to 2-3 percent. Claims are submitted accurately at 98 percent.
Many years ago, doctors graduated from medical school believing that they would run a “practice.” Many simple administrative procedures were neglected, such as:
- Staying current with regulations and insurance specifications so that claims are paid promptly.
- Concentrate on collecting receivables or co-payments.
- Ensuring that fees were kept at the maximum allowable insurance carriers were paying, or
- In order to ensure that claims weren’t rejected or suspended, the procedure codes were always current.
In many offices, the number of outstanding receivables grew dramatically and annual bad debt write-offs became a common practice. But adequate profit margins allowed medical practices to ignore sound business procedures. In the past, medical practice complacency about industry changes is now a thing of the passé. Four years ago, physicians began to pay attention to public opinion on health care reform. Physicians are seeing their profit margins shrink due to the infiltration of managed care companies into the industry. They now realize the importance of adopting more efficient business strategies in order for them to survive into the 21stcentury. Physicians 1st Billing and Claims is prepared to assist local health care providers move through the last of the 20th century and into the 21st century with sound practices that will guarantee business success and, in turn, guarantee quality health care for our families and our country.
Physicians 1st Billing and Claims provides over $9,000 for this business. We need to borrow an additional $5,000. This business plan is very important. This section explains how to use these funds.
1.1 Objectives
- You can open one account before the end of month 2.
- 1500 claims per month, 15
- To become recognized as a local industry expert in the field of medical reimbursement.
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You may also add the following services to our initial offer of electronic claims submission:
- Code optimization
- Analysis of managed care contracts
- Full practice management.
- Customized reporting
- Medical transcription.
- Analysis of fees
- Medicare financial impact analysis.
1.2 Mission
Physicians 1st Billing and Claims, a medical reimbursement consulting company, helps medical practices to become more efficient and to save money by allowing them outsource their medical billing and insurance processing to an expert reimbursement service. We plan to provide a one-stop solution for all administrative needs of medical practice administration by 1998. We plan to make enough profit by 1998 to repay our business start-up loan, and to finance our continued growth and development through our quality service.
1.3 Keys To Success
The Federal Government has been encouraging electronic submissions of insurance claims since 1985. Electronic submission can result in millions of dollars being saved annually, according to statistics. Presently, 95 percent of all pharmaceutical claims and 70 percent of hospital claims are submitted electronically. The percentage of electronic submissions for physician and dentist claims is far lower than that for physicians and dentists, which are only 25-30%.
The Federal Government is not happy that this situation exists so Congress in 1990 mandated that doctors file claims on behalf all Medicare patients. Many doctors weren’t prepared for the avalanche of paperwork. Doctors still manage to get out from under the paper eight years later. In 1996, congress heard the calls for electronic submission of all Medicare claim. No mandate was passed but the paperwork continues to mount up and as baby boomers near retirement age the paper problem will only get worse and those echoes will turn into screams. The United States will issue more than 1 trillion dollars in medical bills this year. This is 9 billion medical claims. Medical practices will be forced to meet the mandates, and growing mountains of paper and most are not currently equipped to handle the transition. The best solution is to hire experts to help you save money, get your claims processed quickly, and make sure that the claims are handled accurately. It is rare for businesses to say that the Federal Government is supporting them every step of the way.
A second key to our success will be flexibility. Physicians 1st Billing and Claims knows that each medical practice has its own unique characteristics. Even practices of the same specialty will have different staff and offer different services. Physicians 1st Billing and Claims assess the needs of each practice and will offer solutions to make the practice more efficient. One person may need all services while another may prefer a specific set of services. Each office’s needs will be considered when billing is done.
Diversified services are the third key. Physicians 1st Billing and Claims gives you a single-stop shopping experience when it comes to medical administrative services.