Tranquilmoney Reports: $125B in Rejected Insurance Claims Challenging Private Practices

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Physicians’ offices must navigate a myriad of regulations and rules to get properly compensated from insurance companies and public payers; but due to billing errors and rejected claims for reimbursement, it is estimated they leave about $125 billion on the table every year. Tranquilmoney founder, Dr. Karun Philip, suggests ways to make billing more accurate and improve the fiscal health of private practice.

Karun Philip, President and Co-Founder of TranquilMoney, discusses billing alternatives for physicians offices.

“If you are still handling your medical billing in-house and your billing errors are high, and if you do not follow up on denials, you may want to seriously consider outsourcing these duties.”

U.S. doctors leave approximately $125 billion uncollected each year due to poor billing practices, serving as a reminder that providing optimal patient care is only one of the big factors in becoming successful in the industry.1 Another major factor is medical practice management, which should ensure that the practice is fiscally sound – but has traditionally been a pain point for physicians. According to Dr. Karun Philip, Tranquilmoney President and Co-founder, there are alternatives to help the physician’s office stay ahead of the curve regarding billing and collections.

Per Philip, there are two main reasons that doctors’ offices don’t always get properly reimbursed: (1) insufficient office staff that are adequately trained on how to complete the forms accurately, checking diagnostic codes, making sure everything is complete, etc.; and (2) the constantly changing landscape of rules and regulations governing what the insurance company and public payers will pay for.

When examining the issue of inadequate trained office staff further, one finds that up to 80% of medical bills contain errors.2 Insurance companies are very strict on correct medical billing and coding practices, so that the smallest mistake can result in a rejected claim. Kaiser Health Care estimated in 2010 that $68 billion in lost healthcare revenue could be attributed to fraud and medical billing mistakes.3 Billing errors can cause a doctor’s office to have to wait several months or more before receiving payment for their services, if they get paid at all.

Philip adds that the second thorn if a physician’s side – the failure to stay up-to-date on medical billing regulations – is made more difficult due to constantly changing rules, requiring physicians and administrators to spend time and money on continuing education, software, or staff re-training to stay current, having a direct impact on the cash flow and profit of the practice.

Compounding the issue, there is a zero-tolerance policy by Medicare and Medicaid for errors and suspected fraud, so that practices may be prevented from billing Medicare or Medicaid services for years.

The risks are not just financial; failure to bill correctly can impact a patient’s treatment due to an incorrect diagnostic code.4

Industry experts estimate that 25-30% of all healthcare claims are denied or rejected. 5 Practices do their best to keep their billing rejections below 5% if possible. Time spent attempting to manage claims denials just delays timely reimbursement even further – especially as most providers use manual processes. But this is avoidable – if the doctor has the technology tools to manage income from insurance companies, medical coding and regulations.

Dr. Philip suggests considering outsourcing your billing and collections. “If you are still handling your medical billing in-house and your billing errors are high, and if you do not follow up on denials, you may want to seriously consider outsourcing these duties.”

Doing so will gives physicians access to a staff of experienced coding and billing professionals and a range of other services that can help their business reduce costs and increase revenue. Medical practices and health care organizations often find they save time, money, and resources when they use an experienced medical billing company, making it well worth the funds spent.6

Specific technology tools from Tranquilmoney give the independent practicing physician the ability to manage office insurance payments, regulation compliance, and medical coding — thereby increasing the focus on patient care.

About Tranquilmoney:
Tranquilmoney was incorporated in 1995 to provide solutions aimed at reversing the trend of doctors in independent practices feeling at a loss with the increased complexity of the business and regulatory side of the healthcare industry. The pattern of physicians selling their practices to large hospitals is one that is avoidable. Tranquilmoney has the tools in place to provide physician practices with financial management services, such as physician receivables management, pharmacy receivables management, healthcare insurance forms processing, and data capture services. In short, doctors can focus on patient care knowing that their practices are in order. The company is based in South Orange, New Jersey with back office facilities in Chennai, India. Tranquilmoney Inc. operates as a subsidiary of MM Group. For more, please see: http://www.tranquilmoney.com/

1     “Medical Billing.” Hospital Billing Errors | Medical Billing Services, Healthcare Business & Technology, 21 Apr. 2011.
2    Loria, Keith. “Easy Tips for Physicians to Reduce Billing Errors.” Medical Economics, 2 Aug. 2017.
3     “Medical Billing Errors Create Significant Costs For Patients.” Kaiser Health News, 5 Apr. 2010.
4    Medical Reimbursement Services. “How Medical Billing Mistakes Can Hurt Your Practice.” Medical Reimbursement Services, 30 Nov. 2017.
5    “Avoiding Denials: 5 Ways to Improve Claims Reimbursement.” Rev-Ignition, 29 Oct. 2016.
6    “How Medical Coding Mistakes Affect Your Revenue?” Latest Updates on Medical Billing - MedicalBillersandCoders.com, 13 Nov. 2014.

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Karla Jo Helms
JoTo PR
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