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Profit from Pressure. Data and Tools for Independent Medical Clinics
Included in the report is an explanation of the challenges clinics face in collection medical payments both from insurance provides and the patient’s self-pay (out-of-pocket) portion.
3300 County Rd. 10, Ste. 100
Brooklyn Center, MN 55429
In the spring of 2011, Outsource Receivables, Inc. (ORI) conducted a survey of independent medical clinics in the Wisconsin and Minnesota region about the rising costs and complexity associated with doing business and their responses to these issues. Just over 400 independent clinics with revenues between $500,000 and $5 million were contacted and 142 surveys completed.
Independent practices face many of the same issues corporate healthcare providers do, including: rising costs, Medicare/Medicaid uncertainty, billing and collection complexity/bad debt, and selecting and implementing EMR (Electronic Medical Record) systems. The independent clinics, however, typically do not have the infrastructure to manage these issues effectively.
The White Paper, released in October 2011, details responses from the clinics and includes internal data from Outsource Receivables Inc.
Included in the report is an explanation of the challenges clinics face in collection medical payments both from insurance provides and the patient’s self-pay (out-of-pocket)
“In order to understand the complexity, ORI conducted a study of the stages in receivables management across a range of independent medical practices in Minnesota
and Wisconsin. The picture looked like this for insurance paid claims:
Step 1 - 19% of all insurance claims are initially rejected
by the insurance companies and require research,
corrections and resubmission to process.
Step 2 - 72% are then resolved within 45 days without
further action — paid per the discount arrangement with
the insurance providers (typically over 50% discount)
Step 3 - the remaining 28% of receivables require active
aging management. For this category, the breakdown is
■ 20% will pay with simple follow-up letters and
■ The remaining 80% require aggressive
negotiations, research, corrections and
This means that 22% of the total insurance charges will not be collected without multiple actions, a strict follow-up regimen, and knowledge of the insurance process.
Self-pay receivables management is not quite as complex but there are strict laws about consumer collections and rising consumer risk. Our study showed that only 40% to 50% of the billings paid without aggressively working the accounts.”
Four strategies for profit in these high-pressure times are detailed at the end of the paper. For a copy of this report, visit www.outsourcereceivables.com/
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Outsource Receivables, Inc. is the premier receivables management resource for medical offices in Minnesota and the Upper Midwest. Our team has a total of more than 125 years of experience in professional medical billing.