Medical practices are being squeezed like never before, a combination of returning patient volumes, higher expenses, staff shortages, greater administrative burden, and slower payments.

Physician productivity is rising as patients finally return to offices following the pandemic years, according to Kaufman Hall. However, expenses for labor and materials are outpacing revenues, especially for practices dealing with support staff shortages, including billers and coders. The stakes are especially high for billers and coders, who are responsible for critical practice reimbursements.

Nearly one-third of billing and coding positions remain unfilled. Until recently, organizations could afford to train billers and coders with rudimentary skills. But as the revenue cycle lengthens and more federal and private payers are turning to retrospective audits to ensure claims accuracy, more organizations are hiring only experienced coders—and paying premium salaries.

Medical practices need reliable and intuitive claims software that can increase their first pass claims rate while boosting support staff productivity.

Reimbursement Taking Longer to Receive
One in eight claims for professional services submitted to payers in 2021 was initially rejected, which means that billing and coding staff had to rework and resubmit the claim. The amount of each denied claim increased 2% to $288, and the time from claim submission to initial payer response increased by three days to 13 days.

It’s no wonder, then, that 74% of providers say it takes at least two statements to collect a patient balance in full, and 37% say it takes three or more.

Longer days in accounts receivable (A/R days), higher amounts of average denials, and less staff spell trouble for physician practices that don’t adopt electronic processes. Manual workflows require more time to submit claims and increase the likelihood of costly denials, creating a vicious cycle of collecting less reimbursement while staff work harder to resubmit denied claims.

Electronic transactions are timelier and cheaper, according to the Council for Affordable Quality Healthcare (CAQH). By fully adopting electronic transaction methods, healthcare could save $20 billion annually. What’s more, medical providers could save six minutes on each claim submitted, allowing existing staff to be more productive.

Electronic Workflows Can Ease Provider Frustrations
Healthcare workers were already feeling the strain from their jobs before the pandemic hit, with physicians reporting burnout at double the rate of the general population. The president of the National Academy of Medicine indicated that in 2021 as many as 75% of clinicians report symptoms of depression, exhaustion, PTSD, and sleep disorders. According to research, burnout costs healthcare $4.6 billion a year.

Burnout leads to clinicians leaving healthcare, with a reported shortage of as many as 124,000 physicians by 2034, according to projections from the Association of American Medical Colleges. Those potential losses include up to 48,000 primary care physicians, 30,000 surgical specialists, and 13,400 medical specialists.

More than 50% of all physicians reported spending 10-plus hours a week on administrative duties, according to a 2017 study. Five years later, the same report shows that physicians are now spending more than 15 hours each week on administrative tasks. The same survey asked physicians about their job frustrations, and administrative duties such as charting and paperwork top the list.

Six in 10 physicians picked bureaucracy related to paperwork as the main frustration. That response outweighed other top responses, which included lack of respect (39%), too many hours (34%), and too little pay (28%). Bureaucratic chores definitely contribute to burnout. More than half (54%) of physicians say that burnout has a strong impact on their lives, with 22% reporting a moderate impact.

Adopting electronic processes, including for claims, can reduce the administrative burden on busy medical practices.

Keep Pace with Changing Codes
Coding practices for management of chronic conditions changed early last year, and providers who are helping patients manage their comorbidities should take advantage. Six in 10 adults have a chronic disease and four in 10 have two or more, according to the Centers for Disease Control and Prevention (CDC). Conditions include heart disease, cancer, chronic lung disease, stroke, Alzheimer's, diabetes, and chronic kidney disease.

Chronic conditions and mental health issues drive 90% of the nation's $4.1 trillion annual spending for healthcare. As Americans age, the incidence of chronic conditions is expected to increase, so these new CPT codes account for clinician time help patients understand and manage their conditions. Principal care management (PCM) is designed for a single condition, while chronic care management (CCM) covers multiple conditions.

Was your practice aware of these new codes? Are your providers and coders taking advantage of them?

CPT codes and their interpretations constantly change, especially from payer to payer. Ensure any claims software is updated frequently and includes the payers your practice uses most often. The goal is to have claims accepted the first time and for the practice to receive the maximum revenue to which it is entitled as quickly as possible.

Let us show you how our electronic claims process can help increase revenue while reducing the administrative burden on your busy medical practice. Sign up for a personalized demonstration to learn more.