To manage medical practices, there are currently billing services. These services help medical professionals with tedious details but seldom offer a way to significantly improve the practice’s bottom lines. 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.
National statistics show that about 70% of insurance claim submissions made on paper are never paid by insurers. With electronic submission Physicians 1st Billing and Claims can increase the percentage of claims paid to around 98 percent.
Additional statistics suggest that the current cost for a medical clinic to process insurance claims on patients is between $8.00-$10.00. These costs can be reduced up to 50% by Physicians 1st Billing and Claims.
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 will usually be able to send claims electronically and have money in the hand of the doctor within 14-18 Days. This will reduce outstanding receivables in proportion and significantly improve cash flow.
Statistics show that paper insurance claims are subject to a 30% suspension/rejection rate. This does not mean that the claims will never be paid. What it does mean is medical staff must hassle with insurance carriers over payment. The percentage drops to 2-3% due to the extensive editing that is done to electronic claims before they reach carriers. Claims are submitted at a 99 percent accuracy rate.
Many years ago, doctors were expected to manage a ‘#8220’ practice after graduating from medical school. Numerous administrative procedures were ignored, such as:
- Keeping current with insurance specifications and regulations, so that claims were paid on a timely basis,
- Concentrate on collecting receivables or co-payments.
- Ensuring that fees were kept at the maximum allowable insurance carriers were paying, or
- Procedure codes were current so that claims weren’t suspended or rejected.
Offices saw outstanding receivables rise dramatically, so it was not surprising that annual bad-debt writes-offs became commonplace. But adequate profit margins allowed medical practices to ignore sound business procedures. The past is gone. Medical practice complacency towards industry change is a thing of the past. Four years ago, physicians began to pay attention to public opinion on health care reform. Physicians are experiencing shrinking profit margins due to the influx of managed care organizations into their 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 contributes over $9,000 to the business. We would like to borrow another $5,000. Please pay attention to this detailed business plan. This section will explain how to use the funds.
- To obtain one account by month two.
- 1500 claims per month 15
- To become recognized as a local industry expert in the field of medical reimbursement.
To include additional services in addition to the initial offering of electronic claims submission.
- Optimize your code
- Analyse of managed-care contracts
- Full practice management.
- Reporting tailored to your needs
- Medical transcription.
- Fee analysis.
- Medicare financial impact analysis.
Physicians 1st Billing and Claims specializes in medical reimbursement. We help medical practices save time and money by helping them outsource medical billing and their insurance processing. We aim to be the one-stop shop for all administrative tasks in medical practice 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. The industry can save millions annually by submitting claims electronically, as evidenced by statistics. Electronic submissions account for 95% of all hospital claims and 70% of pharmaceutical claims. Doctors and dentists are close behind at 25-30 percent.
The Federal Government is not happy about this situation and in 1990 Congress required that doctors file claims for all Medicare patients. This flood of paperwork was not something many doctors expected. Eight years later doctors are still climbing out from under the paperwork. 1996 saw the echoes of Congress calling for electronic submissions of all Medicare claims. Although there was no mandate, the paperwork keeps mounting up. As the baby boomers approach retirement age, this paper problem will only become more severe and those echoes may turn into shouts. This year in the U.S. over 1 trillion dollars worth of medical charges will be issued. This amounts to 9 million 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. It is sensible to outsource the process to professionals who are willing to save money, provide a faster return on insurance, and manage the claims with high accuracy. There aren’t many businesses that can say the Federal Government is behind them all the way.
Flexibility is another key to our success. Physicians 1st Billing and Claims understands that each medical practice is unique. Even practices with the same specialty will offer different services and have different staff. Physicians 1st Billing and Claims will assess each practice’s needs and provide solutions to improve efficiency. Some might need all of the services offered, while others may be more interested in a particular set. Every office’s billing needs will be met by us.
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.