WHERE PRACTICES LOSE MONEY
LEAKS IN THE CLAIMS PROCESS
Most practices are having up to 30% of their potential revenue on the table due to insufficient internal resources, processes, and/or technology
PRE VISIT
PATIENT SCHEDULES APPOINTMENT – PRACTICE CAPTURES INSURANCE INFORMATION
Neglecting to verify insurance eligibility in advance leads to delays and denials
25% Of private payer denials occur because patients are not eligible for benefits.
VISIT
PATIENT CHECKS IN
DOCTOR SEES PATIENT DOCUMENTS VISIT
PATIENT CHECKS OUT
$100,000(Down)
Fating to collect patient co-pays at check-in/out can result in losses of over $100K per year given the difficulty in collecting after patients have left.3
70%
(CD-10 will bring a free-fold increase in diagnosis codes insufficient clinical documentation will slow down the revenue cycle and jeopardize coding accuracy, Unsurprisingly, 70% of practices are “very concerned” about ICD-10% changes to documentation.4
POST VISIT
BILLING STAFF ASSIGNS CODES AND CHARGES, SUBMITS CLAIM TO PAYER
Three common error types cause denials, delays, and inaccurate payments:
- inaccurate patient demographic or insurance information
- Incorrect of suboptimal codes and/or modifiers
- Incurrent charges
60%
ICD-10 will magnify the room for error Almost 60% of practices believe it will be “much more difficult” for coding to staff to choose the right diagnoses codes
PAYER PROCESSES
Paid Correctly
Paid Incorrectly
Denied
Ignored/Lost
Ever when practices get paid on the first try about 1 in 10 payments is incorrect6
Paid Correctly
ICD-10 will make a tough situation worse, CMS estimates:
Denials will be 100-200%
Days in accounts receivable will increase by 20-40%
Denied
PRACTICE APPEALS DENIED SERVICES
65%
65% of providers don’t even try to appeal denied claims due to the associated administrative hassles and cost. 8
14,600(Down)
A typical practice will lose $14,600 per year re-working claims.
PRACTICE BILLS PATIENT
Collecting from patients is difficult:
50% / 70%
Providers typically only collect 50-70% of what they’re owed from patients for small dollar liabilities.12
Obtaining full payment takes an average of 3.3 statements.11
As patient responsibility (copays, coinsurance deductibles) – already at nearly 1/4 of the medical bill – continues to grow, so will practices struggles to get paid.”
