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Increasing Revenue Amidst Decreasing Reimbursements

In the constantly changing world of healthcare, being a doctor has only become more and more difficult. Not only must providers adapt to new technologies and new programs (Chronic Care Management and Remote Patient Monitoring), but there is also added pressure with decreasing reimbursements and increasing operational costs. In this new marketplace, doctors can feel stretched thin, constantly worrying about revenue while also attempting to treat their patients to the best of their abilities. In this kind of workplace, it is no surprise that 44% of physicians reported feeling “burned out” in a recent survey in 2019[1].

Clearly, providers must be adequately compensated based on their performance. Since the workload of doctors is ever increasing, reimbursements should be increasing accordingly. However, unfortunately, a common complaint heard from doctors is a loss of revenue due to cuts in reimbursements by payors. Can we really expect doctors to survive in an environment like this? Or possibly more seriously, will talented young men and women continue to study for a field where happiness and salary is decreasing year by year?

Since the inception of our company, Enable Healthcare Inc. has been committed to empowering clinics, increasing revenue for every practice that we call clients. In our experience, many doctors are losing out on revenue due to either mistakes by their billers, or carelessness by their billing company. Here are some of the issues that EHI typically sees:

1. Make sure all your services being performed are approved by the patient’s payor

Unfortunately, this is a common occurrence when doctor’s use a suboptimal EMR and billing service. To make sure services are being paid, physicians should evaluate their EOB’s to see if all billed CPT codes are being paid. Additionally, doctors should be paid 100% of all E&M (Evaluation and Management) CPT codes. If denials are even at 10% of all E&M CPT codes, the provider is losing a major part of their patient service reimbursements. Any E&M code denials are due to incorrect billing: incorrect primary DX, incorrect place of service, misuse of modifiers, incorrect bundling with other CPT codes, frequency of use, and patient Eligibility related issues or provider contractual issues.

2. Incorrect Primary Diagnosis (DX)

This is a simple issue that we see far too often. If billers understand coding guidelines and follow Local Coverage Determination (LCD) guidelines, these claims should not get denied. Your biller should be verifying if your DX is matching these guidelines and the claims should adhere to your payer guidelines.

3. Place of service, misuse of modifiers, incorrect bundling and frequency of use

All of these mistakes depend on your billers or billing company’s knowledge of the continuously changing payor rules and guidelines. Attention to detail is critical to avoiding these errors and can be nearly impossible without the use of an AI-based billing platform.

4. Repeated mistakes

Often, billers continuously make the same mistakes, month after month, without realizing their error. Physicians should constantly analyze where these repeated errors are occurring, and change protocols to avoid making them again.

Unfortunately, billing mistakes can make all the difference for a provider and can be the tipping point from a satisfied doctor to one who is “burned out.” If you’re a doctor who’s struggling with revenue or the mistakes listed above, please reach out to find out about EHI’s ARIA, an automated billing platform equipped with machine learning and AI that guarantees revenue boosts as well as elimination of denials.


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