Negotiating profitable contracts with Insurance carriers is critical to the success of urgent care centers. However, considering that Insurance companies constantly want to reduce their costs, this is easier said than done. The key is letting the insurance carriers know how by paying you more they are still going to save cost. We recommend you try these 4 tricks, if done right, these steps will help you negotiate the best reimbursement from the insurance.

Cash flow is the lifeline of any business and an independent medical practice is no different. As a practice owner/ administrator the best way you can ensure this, is by preventing your revenue from being locked in denials. Management of denied claims is still important and will remain so, however the focus needs to shift from management to prevention. The benefits of this shift are huge but so are the challenges of eliminating the traditional retroactive approach.

According to industry sources 90% of all claims denials could be prevented. However, for this preventive mechanism to work and deliver best results, all departments in the revenue cycle need to collaborate and work in cohesion. Once you have cream of the crop practices implemented throughout the processes from patient access to claims submission, you can reduce your future denial rate by 50-60% and enjoy sustained cash-flow.

Table of Content

                             Overview

                      Key#1 Code It Right

                      Key#2 Submit Clean Claims

                      Key#3 Correspondence Is For A Reason

                      Key#4 Effective Denial Management

                      Key#5 Payer Contract Enforcement

                      Key#6 Stick to the Follow up Promises

                      Key#7 Stay on top of your Credit Balances

Overview

Arguably the trickiest piece of the puzzle, Accounts Receivable Management is the holy grail of RCM business. With everything that can be done to send out the cleanest of claims in a timely manner, the insurance would still deny a whole bunch of them for a variety of reasons & it takes skills, understanding & expertise with a consistent ability to keep working on them to resolve such claims. The ever-so-changing healthcare landscape has more dynamic forces working right now, with the ICD-10 in place and several looming changes to the Medicare, Medicaid, and the CHIP plans .

As a result, the Accounts Receivable for an independent practice keeps growing but the reimbursements keep shrinking. According to industry sources most practices, unfortunately, leave as much as 30 % potential revenue on the table. The onus of providing the best care to the patient is demanding & on top of it the pressure of converting the AR into cash flow makes it far from ideal. Payer policies around coding, payer contracts, denials, correspondence coming from the payer they all need to be accounted for to make sure the AR is within the control and the cash flow is optimized.

Per some industry estimates, many leave an average of 25 to 30% money on the table. According to industry sources, this happens because almost 50 % of denials never get re-worked resulting in a 5-7% loss of potential revenue. The primary reason being the lack of time & knowledge to effectively dispute this. Not to mention the cost to collect on these claims & it can add up fast.  

In this white paper, you will learn how by incorporating some industry approved best practices you can stay on top of your accounts receivable and optimize your collections with the potential of up to 25-30 % additional revenue.

What is days in Accounts Receivable?

Days in AR means average number of days a claim is outstanding before it is paid/reimbursed/collected.

It is a significant Key Performance Indicator (KPI) for a medical practice because, the higher the days in AR, the longer it takes them to get paid after providing care to the patient. 

We bring you fresh advice and actionable tips for fully optimizing your revenue cycle and maximizing collections for your medical practice. By following these tips, you can significantly improve cash-flow for your practice while your focus still firmly remains on providing best medical care to your patients.  

We bring you fresh advice and actionable tips for fully optimizing your revenue cycle and maximizing collections for your medical practice. By following these tips, you can significantly improve cash-flow for your urgent care center, anesthesia practice, orthopedic clinic or ASC.