Providers Need Billing Services More Than Ever

We are often asked if medical billing is a good field to enter and how the new Affordable Health Care Act is affecting this field.  While the Affordable Health Care Act has definitely influenced the field of medical billing, it has not decreased the need for educated medical billers.  The key word in that last sentence is educated.  Doctors need experienced, informed people handling their billing.

There have been so many changes in the past few years that it can be very difficult to keep up with all these changes.  Unless your focus is on insurance billing, it is very easy to miss changes that directly affect payments and cash flow.

Here are several examples of current changes that are going to greatly affect providers when the staff is not aware of these announcement flyers that have been sent to the offices.

1.  Last spring our local Blue Cross/Blue Shield sent out a flyer stating that they were requiring taxonomy codes to be included on all insurance claims or the claims would be denied.  Now, no other insurance carriers to our knowledge require taxonomy codes on the insurance claims, but as of July 2014, our local Blue Cross did.  If you didn’t read that flyer and prepare insurance payments from Blue Cross stopped in July.  Those unprepared offices then had to find their taxonomy codes, enter them on the claims in the correct box and resubmit all claims.  We know of many offices that had an interruption in their cash flow as a result of this change.

2.  Just recently our local Blue Cross found yet another way to slow down the claims processing for providers by sending out another flyer that states that in December 2014 (next month) all insurance claims must have the name and date of birth of the policyholder as well as the patient.  This is huge as many offices collect only the patient information, not paying that much attention to the policyholder.  Any claims where the patient is not the policyholder will now be denied.  We are expecting this to also disrupt many provider’s cash flow.

3.  PQRS – As much as we have read and written about PQRS, it will still come as a shock to many offices when an additional 2% is deducted from their Medicare payments next year.  We will hear “Why are they deducting my money again?”  Many providers still do not understand what PQRS.  As a billing service we are educating our providers so that they can decide if they want to avoid the penalty and how they can do that.

4.   With the Affordable Care Act it is now more important than ever that providers are verifying benefits prior to the patient being seen.  Many of these ACA plans have very high out of pocket expenses.  Gone are the days where the provider can simply rely on the amount they receive from the insurance carrier and not worry so much about collecting the patient’s portion (although that was never a good idea – we do know many offices that had that mentality).   It is important that the person doing the billing is on top of ALL billing, including patient billing.

5.  With or without the Affordable Care Act it is also now more important than ever that the providers office is handling denials effectively and working the aging report regularly.  Many offices that do in house billing fall short in this area.  With all of the other changes it is important that providers are collecting on all that they are entitled to.

This is why billing services are still a very good business opportunity.  As we have always said, it is no “get rich quick” scheme.  It is hard work but it is a needed field.  It is also so important to keep up with changes.  Whether they are big or small they affect the income.  It is increasingly difficult for a small provider to keep up with the expenses of a medical practice.  They must find better ways to keep the income steady and maximize their receivables.  Larger practices must make sure that money is not slipping through the cracks since they have so many higher expenses.  Outsourcing to a billing service can be a smart move for both the small and larger offices.


One Response to “Providers Need Billing Services More Than Ever”

  1. linda Says:

    Love this blog. very helpful

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