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Medical Billing Networks Level the Playing Field for Healthcare Providers

When it comes to collecting payment from insurance companies, the decks are stacked against the medical provider. Insurance companies have the clout to control the billing process, putting practice owners at a distinct disadvantage. Medical billing networks, a new approach to outsourced internet billing, promise to level the playing field by allowing providers to achieve the same economies of scale as the payers.

Medical Billing Today
The current Byzantine system allows insurance companies to set up countless hurdles blocking payment, in the form of procedures, codes, and rules. Dr. Sigmund Miller, executive director of the Association of New Jersey Chiropractors, points out that, at the expense of medical providers, payers are benefiting from the increasing complexity of billing procedures.

Common insurance company strategies to prevent timely collection include:

  • Complex procedures and coding rules. Payers take advantage of individual practitioners unreliable billing practices, which lead to bureaucratic errors and omissions. About twenty percent of medical bills go unpaid as a result of bureaucratic errors and poor provider follow-up. Coding errors are the basis of the claim denials and payment delays that can decimate a practices collections.
  • Allowed fees. Insurance companies also leverage their scale to reduce allowed fees through consolidation. Medical billing service expert Yuval Lirov explains that insurance industry consolidation has reduced competition for physicians services, resulting in providers being paid less.
  • Post-payment audits further reduce collection rates. Again, the payers size contributes to their clout in demanding refunds. Operating with a vast claims database, insurance companies possess a reliable record on which to base post-payment audits.

In these three respects, insurance companies are able to leverage their size and efficient billing system to limit payments to medical providers.

The Advantages of a Medical Billing Network Service
Individual medical providers have little recourse against these tactics. Collectively, however, medical practices can achieve enough influence to remove some of the hurdles to bill collection. Medical billing networks boast several key advantages for practitioners:

  • Improved collections
  • Lower audit risk
  • Efficient practice management
  • Added revenue sources

How Does it Work?
Outsourced medical billing services offer a mechanism for individual practices to band together. These services leverage the data of all clients in an accountable and efficient automated system. Insurance companies, explains Erez Lirov, already take advantage of this economy of scale and benefit from a large data set, efficient processes, and streamlined management. Billing networks promise to deliver the same value for providers by using the knowledge gained from processing claims numbering in hundreds-of-thousands every month; claims from many individual providers across the nation.

By combining data from numerous clients, medical billing services offer hope to individual medical practitioners struggling to compete with large-scale insurance payers.


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