Medical billing services exist today to help with the management of medical practices. These services help medical professionals with tedious details but seldom offer a way to significantly improve the practice’s bottom lines. Physicians 1st Billing and Claims will not only free office staff for more crucial tasks, but will also maximize return from insurance carriers.
National statistics indicate that only around 70% of insurance claims initially submitted on paper get paid by insurance carriers. Electronic submissions can raise the percentage of claims to around 98% with Physicians 1st Billing and Claims.
Additional statistics suggest that the current cost for a medical clinic to process insurance claims on patients is between $8.00-$10.00. Physicians 1st Billing and Claims can reduce these costs by 50 percent or more.
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 is able to have money in the doctor’s hands within 14-18 working days by electronically submitting claims. This reduces outstanding receivables and greatly improves cash flow.
Statistics show that there is a 30% rejection rate or suspension for paper insurance claims. This does not necessarily mean that claims are never paid. The only thing it means is that medical staff will have to fight with insurance carriers about payment. With the extensive editing performed on electronic claims prior to their transmission to carriers, this percentage is reduced to 2-3 percent. Claims are submitted accurately at 98 percent.
Many years ago, physicians were taught that they would be running a practice. Numerous administrative tasks were overlooked, including:
- Keep current with all insurance regulations and specifications to ensure that claims are paid promptly
- Concentrate your efforts on collecting receivables.
- To ensure that fees are kept as low as possible for insurance carriers,
- Procedure codes were current so that claims weren’t suspended or rejected.
For many offices, outstanding receivables grew tremendously and annual bad-debt write-offs became routine. Medical practices could ignore sound business practices because of their profit margins. In the past, medical practice complacency about industry changes is now a thing of the passé. Physicians’ heads raised and they began taking note of public opinions toward health care reform issues four years ago. Physicians are losing money due to the increasing number of managed-care organizations entering the industry. Physicians are becoming more aware of the need to improve their business processes in order to stay in business in the 21st Century. Physicians 1st Billing and Claims is ready to support local health providers in moving through the 20th and 21st centuries with sound business practices. This will help ensure that quality health care is provided for our families and the country.
Physicians 1st Billing and Claims has contributed over $9,000 towards this business. We would like to borrow another $5,000. This business plan is very important. This section explains how to use these funds.
1.1 Objectives
- To open one account by the end month two.
- 1500 claims per month to be processed 15.
- To be recognized as an expert in local medical reimbursement.
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To include additional services in addition to the initial offering of electronic claims submission.
- Optimization of code
- Managed care contract analysis.
- Management of the entire practice.
- Reporting tailored to your needs
- Medical transcription.
- Fee analysis
- Medicare financial impact analysis.
1.2 Mission
Physicians 1st Billing and Claims (Patients 1st Billing and Claims) is a medical reimbursement consulting business that helps medical practices become more efficient and cost-effective by allowing them the ability to outsource their insurance processing and medical billing. We plan to provide a one-stop solution for all administrative needs of medical practice administration by 1998. We aim to make enough money to repay our loan to start our business and to continue to grow our service.
1.3 Keys to Success
The Federal Government has been encouraging the electronic submission of insurance claims by the health care sector since 1985. Statistics prove that electronic submission can save millions of dollars annually for the industry. Currently, electronic submissions are used to submit 95 percent of all claims for pharmaceuticals and 70 percent for hospital 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. Many doctors were not prepared for this deluge of paperwork. Eight years later, doctors still struggle to climb out from beneath the piles of paperwork. In 1996, the congress was hearing the motions to require electronic submission for all Medicare claims. No mandate was passed but the paperwork continues to mount up and as baby boomers near retirement age the paper problem will only get worse and those echoes will turn into screams. Over 1 trillion dollars in medical charges will be issued this year in the United States. This is equivalent to 9 billion medical claims. These mandates will force medical practices to comply. There are growing mountains of paperwork, and many aren’t equipped to manage 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’ a lot of businesses that can say that they have the Federal Government backing them all the time.
Flexibility is another key to our success. Physicians 1st Billing and Claims knows that each medical practice has its own unique characteristics. Even practices of the same specialty will have different staff and offer different services. Physicians 1st Billing and Claims can evaluate each practice and suggest solutions to make it more efficient. Some people may require all our services. Others may choose to only use a handful. We will tailor our billing to meet the needs of each office.
Our diverse services are also key. Physicians 1st Billing and Claims provides a one-stop shopping experience for medical administrative services.