The Problem: Insurance Companies Hate To Pay What They Owe
As you probably know, the whole process of filing insurance claims is cumbersome, time consuming and energy-draining. The insurance companies have made it as difficult as possible to get paid. Obviously they have a vested interest in paying out as little money as they possibly can. One of the best ways they hang on to their money a little longer is by creating an extremely difficult set of hoops that doctors have to jump through to file and collect their insurance claims.
This arduous process is probably all too familiar to you already. First, one must spend an average of 10 to 15 minutes filling out the CMS 1500’s. This could take hours a day if one has numerous patients. If there are any minute details on the paperwork that are not filled out correctly, the insurance company rejects the entire claim and sends it back to you—unpaid. Then one has to figure out what the problem is, attempt to fix it, and then re-submit the claim and hope it is right the second time around.
The results of this frustrating process are startling: On average 32% of all claims are rejected, 5 to 15% are lost in the shuffle and never collected, and the average time it takes the doctors to collect their money is 60 to 90 days. It can be even longer for Medicaid claims.
In addition, aside from stretching the time it takes to receive payment, this process also presents one with another major problem: it takes a tremendous amount of employee and overhead cost for one to manage the entire claims filing process. In fact, the New England Journal of Medicine states that a typical doctor's overhead and billing expenses account for 43.7% of his/her gross income. This translates into an average of about one and a half clerical workers per doctor at an average annual cost of $51,564. This does not include the hidden costs like vacation time, insurance, and the like.
The Solution: Electronic Medical Claims Filing
Electronic medical claims filing now comes into play. Instead of relying on staff to laboriously file claims and then endlessly follow-up on them through the approval and collection process, now a physician can outsource the entire process to a medical billing professional. Profit Recovery Solutions Inc. can also lower the time it takes to receive payment from an industry average of 90 days to as little as 7 days. We are trained professionals who are equipped with proprietary, state-of-the-art software that allows us to electronically file claims for you. The benefits to your practice are enormous.
Eliminate Software Hassles
We all know that the Internet has changed our world. Our Practice Management System is automatically upgraded on a daily basis and requires no complex installations. You have access to your client's data 24 hours a day, 7 days a week via the Internet.
Benefit #1: Speeds Up the Payment Process
Next Generation Electronic filing drastically reduces the amount of time it takes to collect payments from the insurance companies from 60 to 90 days to just 7 to 21 days. This is possible because electronically filed claims are handled by computers instead of human "gate keepers" at the insurance companies . These "gate keepers" are the ones who ultimately determine whether or not one should be paid. However, when claims are handled by computers there are no people to bog down the process.
Benefit #2: Lower Claims Rejection Rates
The rejection rate for claims utilizing our service can plummet from over 30% to under 2%. Obviously, claims that are not rejected move through the system more quickly. In addition, claims that are mysteriously "LOST" by the insurance companies and never paid are eliminated altogether. Claims cannot be lost when using electronic medical claims filing because they produce an acceptance report from the carrier that ensures receipt.
Benefit #3: Frees Your Time
This benefit is not always quite so obvious to doctors, but is very significant nevertheless: doctors spend as much as one and a half to two hours a day supervising and working on insurance claims. At the very least, physicians have a high-paid staff person working on filing the claims. Our system can give you more time to either see more patients, and therefore make more money, or spend more time doing what you want to do. This also frees up the time of your staff members, allowing them to make more patient calls and run the office more efficiently.
Benefit #4: Immediate Cost Savings
An office can realize an immediate cost savings when outsourcing it's billing to us. A recent survey in the Medical Group Management Journal showed that the average cost of internal billing departments was 11% of the practices' income. Our billing services, on the other hand, charge much less to perform the same service, depending on the volume and complexity of the situation.