Doctors and medical specialists, take note: it’s not business as usual anymore.
According to a media release by Practice Management Institute (PMI) *, nearly 80% of medical bills and claims submitted to insurance companies carry errors and about 55% of evaluation and management claims are coded wrongly causing huge losses to the practitioners of medicine in the USA.
(* PMI is the premier institution in the USA that addresses coding, billing, management and compliance for admin staff in outpatient medical facilities. Over 20,000 medical office professionals have earned their specialised training and certification from PMI, to conduct medi-claims, insurance cover, billing and medical codes with related functions to industry standards.)
The sad part is that most of the practising doctors and medical specialists who bear the responsibility for all claims billed under their name and signature are not fully trained or competent enough to understand the impact and intricacies of the claim statement and hence, end up losing out legitimate claim amounts. Yet, they do not employ competent staff with certifications and thus attract heavy losses due to filing of incorrect claims.
The survey estimates that such losses have mounted up to $68 billion in the industry! Incorrectly coded medical claims alone resulted in wrong payments touching nearly $6.7 billion in a year.
The mistakes have cost many a doctor, a heavy price.
PMI watchdog sources reveal that enforcements and penalties have been increased on this front in recent times. Under the Affordable Care Act, the healthcare protection umbrella for all, 17000 medical providers have been identified as defaulters and their certifications to bill medicare services have been terminated.
The medical practitioners have found a way out of the situation – they are now looking out for ways to increase the training standards for administrators and also are willing to hire those with high professional certification.
Narrating the overall need for better standardization needs in the administration of medical claims, a Director of PMI illustrated the situation well in his words: “Physicians dedicate their careers to quality patient care; most have had little exposure to the increasingly complex world of medical claims management. They rely on their billing and administrative staff to stay on top of the guidelines set forth by Medicare and third parties. PMI helps providers adopt higher training standards with specialized courses and certification exams that address these high-risk areas of practice administration,”
When the medical practitioners become fully aware of the critical need to employ certified and competent admin staff to prepare their medical claims and billing statements, physicians are more likely to submit accurate data and receive correct payments.
This would reduce the liabilities currently faced by the practitioners to a large extent, feels the standards authority.