How Can Healthcare Providers Handle Situations Where They’re Being Underpaid?

Handle Situations Being Underpaid

Just like ordinary people, working in different sectors. Being underpaid is also frustrating and demoralizing for the healthcare providers too. Talking about patient care and financial gain at the same time may sound weird. But one can’t deny the reality that medical providers need a consistent cash flow to meet their basic medical expenses.

So, gone are the days. When it was considered taboo to talk openly about financial management as well as patients’ health. Now in this modern era, healthcare providers have realized that they need to work on the financial well-being of their practices.

Because in order to keep pace with the highly competitive healthcare market. And to stay ahead of the competitors, it is crucial to stay financially strong. However, in this pandemic hit era, healthcare practitioners are facing immense challenges. When it comes to collecting revenue for the medical care services rendered. Just think for a while, how can you keep your business running smoothly without having a consistent cash flow?

The majority of the healthcare providers are still underpaid, despite delivering standard medical aid to the patients. In order to dive deeply into the issue related to underpayments, delayed or denied payments. We approach the healthcare providers who are associated with the industry for a considerable amount of time. According to their opinions, based on experience, facts, and figures, the major reasons behind the constant revenue loss are the following:

Institutional Causes For Revenue Leakage

The widening gap between the payment collections that medical practitioners owed and the collected revenue is worsening. Failure to cope with such a financial situation immediately can result in a critical economic crisis. Industry experts reveal the following common issues that hold healthcare providers back from getting reimbursed:

  • Inconsistency in maintaining uniformity of charges and actual payments that medical practitioners received.
  • Failure to develop and distribute well organised financial policies among the patients and all stakeholders.
  • Delay in patients’ copays and deductibles.
  • Federal regulation requires the charges for all patients to have a uniform plan. But most of the healthcare facilities have rules for payments as different for all.
  • One of the major reasons behind revenue loss is inefficient healthcare revenue cycle management. That includes coding errors and inefficient medical claims management, which ultimately results in frequent claim denials. Due to the growing complexities in managing the revenue cycle. The denial percentage of many healthcare organizations has surpassed the average industry limit i.e. more than 10%. So, in order to avoid the financial crunch, medical practitioners should examine their denial rates. And the entire medical billing system to identify and eliminate the red flags in it.

Quick Tips to Deal With Underpayments


1. Know What You Owe:

No doubt, dividing and reviewing the insurance payers’ contracts is a time-consuming and hectic task. But healthcare providers should never overlook this aspect. Because doing so is crucial to know what payers are supposed to pay before medical professionals go out and get it.

The best thing you should do is: to prepare a comprehensive spreadsheet after analysing the agreements of all payers and their contracted rates. In this way, you can get a complete financial picture of which healthcare services you are going to get reimbursed. Moreover, after making a spreadsheet, the next step is the comparison of the insurance companies’ rates against each other. It will surely help you to take the next step in determining the low payments.

2. Compile the Entire Payment data:

After compiling the contract rates of the payers. The next useful strategy you can implement is assembling the whole financial statement & reimbursement data from each payer.

You can compile the payment data of the previous months or even one year, depending on your needs and goals. Now you have two separate spreadsheets. Then compare actual payment data to the rates in the first spreadsheet at the end of the period. Are insurance companies not paying what they negotiated in the legal contract? Does it happen rarely or is there a strong tendency to underpay? Collect the information about these questions by closely analysing both spreadsheets and make a report that explains the scope of the issue.

3. Contact With Payers:

Once you find loopholes in the payments received by the insurance agencies. The next step is to speak up for your rights. You should make a proper strategy and report if they are involved in breaching negotiated rates for the healthcare services rendered.

After reviewing the contracts and making a report. Medical practitioners should contact and hold a one-to-one meeting with the person at the payer, responsible for negotiating the original contract. It’s very crucial to set a clear goal whether healthcare provides will demand the previous payments or simply wants accurate payments in the future. If the insurance agency becomes non-responsive and doesn’t cooperate in reaching the best possible solution. You should move towards taking legal action. This problem may sound a little bit boring, time taking and of course difficult to handle. But it exists in the healthcare industry and medical care providers are losing significant revenue due to this issue.

4. Manage the Claims Efficiently:

We all know the fact that healthcare providers get paid only through the submission of error-free medical claims. Because insurance companies usually don’t accept claims that contain certain errors. Such as incorrect patients’ demographic information or medical codes.

Therefore, it is the responsibility of healthcare practitioners to implement smart medical billing solutions to get their claim’s first pass resolution rate as high as possible. Are you leaving thousands of dollars uncollected due to the high percentage of claim denials? If so, then don’t worry. With the implementation of the following strategies, you can come out of this tough financial situation & make your practice thrive.

Collect accurate patients’ data:
Failure to capture accurate patients’ data is still a major cause for claim denials. Because medical claims containing incorrect patients’ demographic information such as; name, date of birth, gender, age, phone number, mailing address, and insurance information, usually get denied. However, in order to prevent claim denials due to such reasons. It’s important to hand over the front desk responsibilities to the highly trained staff.

One of the best actions you can take is the integration of the EHR solutions to upgrade your medical billing system from an outdated to the upgraded one. Automation of administrative tasks eliminates the chances of human errors. And elevate the productivity as well profitability of your medical practice.

Prepare clean medical claims:
Any section on the claim form left blank or wrongly filled ultimately results in denials or rejections by the payers. Therefore, make sure that your billing staff works diligently to prepare and submit error-free medical claims.

They must have a complete understanding of the claims formats and guidelines of all insurance payers. Moreover, make sure that medical claims contain the following components:

  • Precise demographic details of the patient.
  • Complete details of healthcare providers including; NPI number, Federal Tax ID, etc.
  • Accurate medical codes for the patient’s diagnosis, procedures, treatments, equipment, and healthcare services, a patient received.
  • Accurate modifiers that clearly describe the factors that altered the medical procedures due to some reasons.
  • Individual charges for every listed procedure or medical service.
  • Total charges for the entire procedure.
  • Medical facility details.
  • Date of service provided.

Ensure timely submission of claims:
Every insurance company has its own time frame for submitting the claims. Payers usually don’t accept the claims that are being filed after expiring the filing limits. Therefore, it’s crucial to file error-free claims in a given time window of the insurance companies. In this way, healthcare providers can get maximum reimbursements without any delay.

5. Collects Co-pays/Deductibles Upfront:

Patients’ financial responsibility i.e. co-pays & deductibles play a vital role in the revenue of the healthcare practice. But in his challenging era, practitioners are facing immense challenges while collecting payments from the patients. That ultimately results in underpayments. The best initiative you can take is to train your front desk staff to ensure patient collections at the time of services are provided. In addition to this, here are the following tips that can help you in this matter.

  • Ask your administrative staff to clearly describe the estimated costs of the services when a patient comes for the registration. In this way, they can make a better decision than whether or not they can afford the healthcare services.
  • Offer flexible payments options including credit/debit cards, web banking, or other digital methods.
  • Prepare comprehensive medical bills that don’t contain jargon or complicated medical terms that a patient cannot understand.
  • Develop a proper financial policy.

By implementing the above-mentioned strategies, you will no longer remain underpaid. So, take action now and don’t let your hard-earned revenue be left uncollected. So, take your practice to the highest levels of profitability. Find this article helpful? Then stay connected with the Medical Billing Benefits. It’s a live healthcare newswire that keeps its readers always updated about the latest happenings in the healthcare industry. For more updates on healthcare management and technology, subscribe to our news feed.

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