Physician Billing Solutions for Small Practices

Physician Billing Solutions for Small Practices

As of 2020, nearly half of patient care physicians work in physician-owned medical practices according to an analysis conducted by the American Medical Association (AMA).

Operating a private practice is a rewarding but challenging endeavor. Physicians in private practice build meaningful relationships with patients over the years. They also have greater autonomy over their work and operate on a personalized schedule.

However, between concerns like increased operational responsibilities and keeping up with changing claims regulations, physician practices are up against increasing threats. Practices also continue to feel the ongoing effects from the COVID-19 pandemic.

Despite the threats, physicians in private practice have the opportunity to conquer these challenges and enable their practices to thrive with a strong medical billing platform.

A highly impactful method to creating a highly successful private practice is identifying physician billing solutions and improving revenue cycle management.

NCDS Medical Billing has outlined the challenges and opportunities that small practices face. You'll also learn how to enact physician billing solutions to make the most of your practice and provide quality patient care.

What are Physician Billing Solutions?

Physician billing can also be known as professional billing. This is the process that healthcare providers and physicians undergo to submit claims in order to get paid by healthcare insurance companies.

Physician billing solutions are built in order to create a custom-fitted revenue cycle solution. These solutions are backed by billing and coding experience in that specific medical specialty.

A strong physician billing solution applies resources and business expertise to meet the unique needs of each individual practice.

Employing a physician billing solution helps maximize the revenue that small practices earn by providing patient care.

NCDS Solution: We have been in the medical billing industry since 1985 with a focus on providing revenue cycle solutions and resources to independent healthcare providers. As a privately owned business ourselves, we appreciate the perspective of our physician clients operating in private practice and cater our services to these needs.

With expenses for healthcare providers rising, lost revenue hits small practices hard. Small practices feel the pressure now more than ever.

MGMA data on payer payment audits.

24% of medical groups never audit their payer payments versus the contracted rates. By never auditing, these groups could be leaving revenue on the table. One major strategy for maximizing revenue is conducting these audits - and physician billing solutions help with that.

What is the Difference Between Physician Billing and Hospital Billing?

Physician billing and hospital billing are two distinct types of medical billing.

For starters, while both physician and hospital billing are under the umbrella of medical billing, physician billing has the alternative name of “professional billing”. Hospital billing is known as “institutional billing”.

These two terms have been differentiated based on their purpose and what services are included within the billing process.

Claim Form Differences

Physician billing and hospital billing both have paper and electronic forms, but these forms are different.

For Physician billing, CMS-1500 form or the 837-P forms are typically used for billing claims. The P in 837-P stands for Professional Configuration. These two forms are the same, but CMS-1500 is the paper form, while the 837-P is electronic.

Hospital billing uses either the CMS-1450 form (also known as the UB-04) or the 837-I form for billing claims. The I in 837-I stands for Institutional Configuration. Additionally, the UB-04 represents the paper version of the form, and 837-I is the electronic version. 

NCDS Solution: When you are an employed physician operating in a large healthcare system, your smaller value claims are often overlooked by the hospital billing department as the larger facility charges take priority. 

At NCDS, physician claims are the center of our attention, and we can leverage efficiencies across multiple clients to get improved results so no claims slip through the cracks.

Unique Features of Physician Billing

Physician billing has a few unique characteristics compared to hospital billing and is essential to building effective physician billing solutions.

• This type of billing includes services that can be both in-patient and out-patient. Many of these services can only be billed after patient verification.
  • Patient verification is a necessary process, as these services will be billed in accordance with patients’ insurance policies.
• Medical coding is included in the physician billing process.
• Physician billing is a multi-step process, including scheduling, registration, payment collection, patient check-in, etc.

Unique Features of Hospital Billing

While physician billing is complex as small practices handle all aspects of administration, hospital billing has its own form of added complexity. This is due to operating within a much larger system.

• Hospital billing includes bills for additional services conducted by skilled nurses or medical facility usage.
• This type of billing does not deal with medical coding, unlike physician billing which does include medical coding.

Challenges for Small Medical Practices

Small medical practices provide top-notch and personal care to patients. These practices own a large portion of the healthcare provided in modern medicine. In fact, according to Statista data, ~56% of medical practices had 10 or fewer physicians as of 2018.

Statista data on medical practice size

Small practices are vital to creating healthy communities but are up against some major challenges in the modern healthcare system. The good news is that these challenges are not insurmountable. Physician billing solutions can significantly help practices tackle these challenges and focus on their medical services for their patients.

Increased Administrative Burden

Small healthcare providers have the challenge of staying on top of both the clinical responsibilities and the administrative side of running the practice. Time spent on administrative tasks takes away from time spent with patients.

With an increased burden on the administrative side, many practices are turning to physician billing solutions such as automated medical billing. This reduces the tasks like medical coding, prior authorization, and other billing-related needs.

NCDS Solution: Save time and money. At NCDS, all we do is medical billing so you can focus on providing excellent patient care. Administrative costs have been estimated at 25-31% of total health care spending. You can outsource your billing for a fraction of that, reducing your level of expenses and stress!

Declining Payment Rates

Small practices have noted pay rates have been on the decline from sources like Medicaid, Medicare, and commercial insurers. There are also significant differences in payment methods for independent physicians when compared to pay plans for physicians in health systems.

Challenges Submitting Clean Claims

Achieving clean claims is an ongoing challenge for practices. Denied claims waste time and money for providers. Furthermore, submitting as high a percentage of clean claims as possible is crucial to a healthy revenue cycle.

Claims Denials data from KFF

Some issuers deny as many as over 30% of in-network claims according to KFF. So, ensuring clean claims can help combat this increase in denials.

Regulatory Requirement Increase

Independent practices encounter another pressure in ensuring to be compliant with all regulatory requirements. For healthcare providers, these requirements have increased in recent years.

Staying on top of the latest programs, requirements, and regulatory shifts is a continuous challenge. This is especially true for small practices since they maintain all administrative tasks internally.

Identifying a helpful medical billing partner to stay ahead of any industry shifts can save time and money. This also allows practices to get back to patient care.

NCDS Solution: We are an industry leader in compliance, exceeding the standards of the HBMA Compliance Accreditation Program since its inception. NCDS has all the safeguards in place for HIPAA, the Privacy and Security Rules, HITECH, Omnibus, FWA, Stark Anti-kickback, and the OIG work-plan so you are protected too.

Physician Billing Solution Benefits for Small Practices

Small practices play an essential role in communities. Physician-owned practices can build deeper ties with patients and provide a personalized experience. Practices with 1-2 physicians even show 33% fewer preventable hospital admissions than larger practices.

To support and increase the revenue of physician practices, physician billing solutions offer many valuable benefits in order to conquer the challenges listed above.

Medical Practice Efficiency Improvement

A study by the AMA identified that 63% of physicians felt the effects of burnout in 2021, an all-time high in recent years.

Managing a practice’s billing efforts adds stress and additional responsibilities onto physicians’ plates.

By finding a physician billing solution, practices can turn their efforts toward patient care. Outsourcing the burden of medical billing concerns opens up more time to provide the best possible experience at your healthcare practice.

Physician billing solutions can improve billing efficiency, guide on proper billing documentation, accurate specialty billing, and coding guidelines. A physician billing solution also assists in the organization and optimization of processes.

NCDS Solution: Our claims success rate is +2.6% better than our competitors.* Too many medical billing companies operate as a SAAS model, Software as a Service. 

At NCDS, we are a Service as a Service. Our medical billing team gets involved to provide better results, not just push claims through.

* Based on an independent third party report by RemitData for denial rate on claims, NCDS vs. National Peers

Increased Clean Claims

Clean claims are essential to a well-functioning physician practice. Also, Clean claims guarantee that revenue is coming in and providing a healthy cash flow.

When claims are denied, the revenue that a practice brings in becomes stalled. Denials are expensive from both a financial and time perspective. So, ensuring claims are submitted accurately the first time is impactful to your revenue cycle management.

Clean claims are on many healthcare providers' minds. As a result, 48% of healthcare leaders in an MGMA study identified claims as the biggest revenue cycle management challenge.

Working with a physician billing solution will ensure that your practice implements all of the best practices for achieving a high clean claims rate. A physician billing solution will prevent denials and keep you protected from inefficient billing practices.

Decreased Overhead Costs

Hiring in-house staff for medical billing at a small practice is a challenge. Oftentimes medical billing tasks fall to those who are meant to be doing other tasks.

The more time spent on medical billing by in-house teams, the higher the overhead costs are for the practice.

Identifying a strong physician billing solution will safeguard that your practice’s money is used wisely, rather than accumulating increasing overhead costs. A medical billing partner will also provide coding compliance. This will lead to a decrease in rejections, and save time and money by getting claims submissions right upon first submission.

Outsourcing medical billing is incredibly valuable to small practices that may not have time to allocate full-time employees to be dedicated to medical billing. Through physician billing solutions, a small practice can ensure that medical billing is completed in a timely, accurate, and effective manner.

By assigning medical billing tasks to a custom physician billing solution, physicians can focus on patient management and care without the concern of if they will be paid for their work.

Improved Revenue Cycle Management

Healthcare revenue cycle management consists of the financial processes that a practice undergoes. This includes insurance claims processing, making payments, and revenue generation. Overall, revenue cycle management is what keeps a practice’s revenue flowing.

Revenue cycle management is complex and unique to each practice. A well-built medical billing software will be customized to your practice’s needs. This solution will also provide top-tier services leading to improved financial performance and outcomes.

How to Find a Physician Billing Solution

A physician billing solution can make a significant impact on your small medical practice and financial health. By providing efficiency, an improved revenue cycle, and custom expertise for your unique needs, NCDS Medical Billing services are here to help you provide the care your patients deserve.

Contact NCDS to discuss what the right medical billing solution is for you and your practice.

Questions?