99MGMT Blog

Are You Satisfied with Your Current Medical Billing Process?

Posted by 99 MGMT on


As this most tumultuous year comes to a close, many businesses are taking this time to evaluate their performance over the past 12 months, as well as considering their goals for 2021 and beyond - and your medical practice should be no different!

We recently covered the benefits of outsourcing for Revenue Cycle Management, so today we’ll be discussing the importance of addressing your practice’s Medical Billing processes.

Administrative Costs

In recent years, healthcare spending under the umbrella of “Administrative Costs” has been increasing, causing issues for many private medical practices.

Administrative Costs are primarily defined as billing and insurance-related expenses, which accounts for programs like Medicare and Medicaid, as well as actual time spent on administrative tasks, and more.

As a result, private practices across the country are spending so much money on Administrative Costs that could be automated or at least migrated to a digital format that they lack funding for things like potential outsourcing opportunities or even expansion.

Accounts Receivable

In addition to built in Administrative Expenses, medical practices - especially in lower income areas - tend to run into problems with managing their Accounts Receivable, namely with outstanding balances.

As many practitioners in private practices know, your time throughout each day is spread very thin, so staying on top of outstanding accounts can slip through the cracks.

Outsourcing assistance from a reputable practice management or medical billing service can help to take some of that work off the plate of the practitioners who are always looking for ways to optimize their time.

Insurance Claims

More and more, insurance companies are denying claims in the name of “utilization management techniques” they’ve implemented in order to save money, but often end up increasing expenses on the patient-end.

Utilization management techniques include tactics like step therapy, formulary exclusions, and non-medical switching.

  • Step therapy is a process in which practitioners are required to prescribe patients less expensive drugs to try prior to being able to prescribe the actual required medicines. 
  • Formulary exclusions are a process where patients may be denied coverage of a particular prescription if it is not included on the insurance company’s formulary.
  • Non-medical switching is when patients are switched to generic or less expensive versions of their prescriptions if they are not included on the formulary

Though there are options to appeal when claims are denied, this is just an additional way practitioners end up spending time on administrative tasks as opposed to patient care, thus spreading their time even further.

Overall, it is important to evaluate your private medical practice's financial health as the year winds down, that way you can determine if there are places for more efficient use of spend, as well as a more use of your staff’s time.


For more information on Practice Management or Medical Billing services, check out the 99MGMT Blog!

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