Navigating the Challenging Waters of Insurance Reimbursement

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Many changes are taking place in the medical field, and many people are wondering what they need to do to maximize their reimbursement rates. Today, doctors are concerned that their payer mix is unfavorable. However, reimbursement rates are dropping, and that student loans will continue to impact significantly. That is why it is critical to take a closer look at what doctors need to do to maximize their reimbursement rates. What does this mean, and what do you need to do if you want your practice to survive in the current environment?

Verify Insurance Coverage Before Seeing a Patient

Your time is your most valuable resource. If you spend time-fighting with the insurance company, you will not spend as much time building insurance companies for the time you spend with patients. Therefore, your front desk staff should verify insurance coverage before seeing a patient. Too often, doctors wait until the patient arrives at the office to verify their insurance coverage. If someone shows up at the office without any insurance coverage, it is simply too late. You have already wasted your time, and scheduling someone else for that time slot will be challenging. When someone wants to schedule an appointment, go ahead and collect their insurance information ahead of time. Verify their coverage before you see that patient. 

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Have Help Getting Prior Authorizations

Next, you may want to hire someone to help you with prior authorizations. For example, if you are treating severe spinal cord injuries, particularly those that require surgery, you may need to get a prior authorization from the insurance company. This is something that says that the insurance company agrees to cover the cost of the procedure before you see the patient. Navigating prior authorizations can be complicated, and you need to have someone who specializes in this area. Then, if your prior authorization is denied, you understand exactly what you need to do to get it accepted next time. 

Consider Hiring a Third Party

Finally, you should consider hiring a third party that can help you with this. Getting your claims reimbursed by an insurance company can be a significant challenge. You want to spend your time helping patients. You did not go to medical school to deal with insurance companies all day. If you are tired of spending time on the phone fighting with an insurance company, you should reach out to a third party that can help you. That way, you can focus on doing what you love while a third party maximizes your reimbursement rates. Furthermore, if you decide to hire a third party to help you, you might find that you can get paid more quickly. 

Maximize Your Reimbursement Rates

Even though there are many challenges with the business side of medicine, there are many opportunities. The medical field is changing quickly, patients expect more from their doctors than ever before, and there is more demand for quality care than there was in the past. As changes in the medical field continue to grow and evolve, doctors need to work hard to stay ahead of the curve. That way, they can put themselves in a position to compete in the current environment while also maximizing their payer mix. Remember that this is not necessarily something you must navigate on your own. Instead, you may want to reach out to a professional who can point you in the right direction.