Would a nephrologist treat a patient’s Parkinson’s? Would a dermatologist administer treatment for arterial sclerosis? Would a podiatrist care for a patient who presents with symptoms of lung disease? Not without consulting the appropriate specialist, they wouldn’t. After all, doctors are experts in specific fields. When a patient requires care outside the doctor’s area of expertise, the patient is referred to the doctor with the needed training and talent.
And just like doctors cannot be experts in all fields, they also cannot be expected to be knowledgeable in medicine and business. However, a reimbursement specialist is an expert in the time-consuming aspects of the business of medicine. And just as physicians refer patients to other specialists, they should also refer the business of revenue reimbursement to a reimbursement specialist.
In an article in the New England Journal of Medicine, Matthew M. Davis, MD
said, “Without education in health policy and the healthcare system, physicians are missing critical tools in their professional toolbox.”
A study conducted by the AAMC found that 65% of medical students felt they got an inadequate amount of training in how to navigate the healthcare system during the first two years of medical school. They reported they were poorly prepared to handle the economic side of medicine. Furthermore, 49% of medical students claimed that economic issues weren’t covered during their clinical experiences, either.
What happens is the newly-certified doctor begins practicing medicine. Immediately, they get bogged down. Medical offices and hospitals are hectic. Doctors and nurses are bustling around, busy with patient charting and logging information, on top of patient histories and dialogues with patients. When a doctor has to focus on administrative details, they cannot devote their full attention to growing their practice and administering patient care.
A reimbursement specialist can prove invaluable in many ways. Working with insurance claims and the government, their expertise can result in an increased reimbursement rate as well as greater patient satisfaction. After all, would patients prefer their doctor spend more time in the exam room or more time on the phone with insurance carriers? The answer is obvious…
Fee analysis would be the responsibility of the reimbursement specialist, along with managing the denial process. Resubmission of claims would no longer be delayed because the doctor is too busy with patient care. Capturing lost revenue would be possible with a professional who specializes in reimbursement.
Translating patient information into the standard code would be done by the reimbursement specialist. They would navigate through the complicated governing policies and procedures. Also, they would generate an easily-understood report to the insurance agencies, leaving the doctor time to give one-on-one attention to their patients.
Research has shown that each form that comes across a doctor’s desk is touched a dozen times before anyone acts on it. Should physicians get mired in the inefficient paper shuffle, or should they delegate the paper piles to the reimbursement specialist? Should doctors spend hours every evening, after their office has closed, to whittle down the towering stack of forms, leaving them no time for a life with their family?
A reimbursement specialist can be the answer to those questions.