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.”