Are Primary Care Claim Denials Increasing Revenue Loss?

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Yes,  primary care claim denials are increasingly contributing to revenue loss for physician practices by delaying reimbursements, increasing administrative workload, and weakening overall revenue integrity. As payer scrutiny intensifies and documentation requirements expand, primary care practices across the country are seeing a measurable rise in denial rates that directly affect operational stability and financial outcomes. Primary care providers operate on high patient volumes and relatively thin margins. When denials increase—even slightly—the cumulative impact can significantly reduce collections and ultimately affect a practice’s ability to yield EBITDA . Understanding why these denials occur and how to prevent them is essential for maintaining a healthy revenue cycle. The Growing Impact of Primary Care Claim Denials In recent years, payers have strengthened claim review processes, automated adjudication systems, and documentation requirements. These changes have led to...
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Choosing Desired Medical Billing Company for Your Practice

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Outsourcing your revenue cycle operations to a medical billing company is the right move toward securing the financial stability of your practice. However, choosing any medical billing company could cause more headaches than benefits. Medical Billers and Coders is a leading medical billing company providing complete medical billing and coding services. While interacting with our potential clients, we found difficulties that are faced by healthcare practices while choosing the desired medical billing company.

Evaluate Your Practice’s Pain Points

As you are seeking external help in Medical Billing and Coding for your practice, there are some pain points that are badly affecting your practice’s revenue. List down all those pain points and try to evaluate if that medical billing company can provide solutions to those pain points. Major pain points for any healthcare practice include hiring and retaining skilled (and experienced) staff, training costs, non-availability of a certified coder, submitting paper claims, difficulty in transition from paper claims to electronic claims, Insufficient knowledge of practice management software, denied claims, receiving fewer reimbursements and many other. Once you have a list of your preferences and challenges, you will be more easily able to communicate them to potential medical billing companies.

Questions to Ask Prospective Billing Companies

  • How often do you submit claims?

If you submit claims quickly, you will get paid quickly. So, ask the medical billing company, how often they submit claims for your practice. Ideally, it should be less than 24 hours while some companies would take up to 5 working days to submit a claim. Billing and coding experts from MedicalBillersandCoders (MBC) submit claims within 24 hours after patient visit details are shared by providers. 

  • What’s your clean claim percentage?

Just submitting a claim is not sufficient, all the details mentioned in that could be accurate i.e., a clean claim. It’s quite obvious for any practice to have less than 80 percent as a clean claim ratio. The standard is 90 percent while MedicalBillersandCoders (MBC) achieves more than 95 percent of the claim ratio for all our clients. 

  • How do you handle rejections?

Entering any inaccurate information while submitting insurance claims will lead to claim rejections. It’s acceptable practice to have up to 5 percent of claim rejections as patient demographics and insurance information get updated, focusing on how the medical billing company handles rejections. MedicalBillersandCoders (MBC) crosschecks provided patient and insurance information against the payer database before submitting a claim. 

  • Do you have certified, specialty-specific medical coders?  

Inquire how many certified coders they currently have on staff and how many will be dedicated to your account. Ensure that these certified coders have good experience in coding in your medical specialty.

MedicalBillersandCoders (MBC) appoints certified coders to your account and adjusts the number of coders on your account as per workload. 

To learn more about Choosing the Desired Medical Billing Company for Your Practice, click here: https://bit.ly/3EgCTek Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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