Vendor Allies: The Partners Who Help You Optimize Payment Performance

December 1, 2015 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management, Practice Management

Amid dwindling reimbursements, ICD-10 challenges, and the rise of high-deductible health plans, medical practices are increasingly pulling away from payers. Some are switching to concierge care, others are testing the waters with self-pay patients and rate-card pricing, but almost all physicians and medical practice managers are expressing frustration at the changing healthcare landscape.

The challenges of working with insurers are well-documented, and many of the practices trying new approaches to payment are doing so with success. But what’s a practice to do if it’s not interested in changing its model? Cutting payers out of the revenue cycle is a non-starter for many traditional medical practices and healthcare groups – especially those with small or aging patient populations.

How do you optimize revenue without making a major change to the structure of your medical practice? By leveraging the power of vendor allies.

Payers Face Challenges, Too

Faced with so much insurer-related frustration, doctors often neglect to recognize that payers are in a belt-tightening moment of their own. Decreased reimbursements and ballooning deductibles hit them where it hurts, too, and payers now face the added challenge of being on the receiving end of bungled ICD-10 claims from confused billers and coders across the country.

As such, the antagonism between providers and payers is, unfortunately, two-sided – making it even more difficult for both sides to find common ground. But in between the two adversaries are valued third parties… third parties who benefit immensely from facilitating seamless relations between doctors and insurers. Here’s who we mean (and how they can help you get a handle on payer problems).

The Medical Billing Company: Outsourced medical billing services have been navigating payer-provider relations for decades on end. That doesn’t make them dinosaurs; in today’s in-transition healthcare system, the experience of a trusted medical billing company can be invaluable to your bottom line.

Why? Because medical billing companies have long-term relationships with payers – relationships they can leverage to resolve billing issues more easily than your internal back-office team may be able to. And since billing services are on the hook for delivering measurable improvements to your revenue (and reporting to you the results), they make an ideal ally for your practice’s success with payers.

The Healthcare IT Provider: While less a straightforward partner than a medical billing company, your IT vendor may have data-driven insights into payer performance that can help you optimize claims submission and reimbursement effectiveness. Today’s modern electronic healthcare record (EHR) and practice management systems come equipped with reporting capabilities and benchmarking tools that can help you boost efficiencies across the board.

“Cloud-based technology that handles EHRs and [supports] revenue cycle management collects tremendous insight into payer performance and can expose real areas for performance improvement,” says Tom Mohr, MD, President and CEO of Pediatric Partners. “We've benefitted from greater transparency into the dynamics that create inefficiency and cost across the supply chain, to better respond to industry change.”

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