| Insurance companies are definitely in a stronger | | | | amount. |
| position in the 'payer payee' relationship shared with | | | | Post-payment refunds |
| healthcare providers. They have the advantages of | | | | Insurance firms conduct post-payment audits to |
| scale, power and a large claims database. The | | | | correct mistaken payments and redeem them. They |
| complexity of billing procedures further tips the scales | | | | have access to a vast claims database and can |
| towards them. Technology and the internet come to | | | | verify records to demand post-payment refunds. This |
| the aid of medical providers through medical billing | | | | further depletes the revenue of medical practitioners. |
| networks, promising to level the playing field between | | | | Insurance companies have an efficient billing system |
| the two players. | | | | that allows them to reduce payments to healthcare |
| Insurance carriers benefit from complex medical billing | | | | providers. The added advantage of scale makes them |
| process. Changing codes, rules, and procedures make | | | | a tough proposition. |
| filing claims tortuous and error-prone. Insurance | | | | Medical billing networks reinforce the medical billing |
| companies pick on these errors to reject claims. | | | | process |
| Sometimes this happens repeatedly till the medical | | | | Medical billing networks consolidate the claims |
| provider caves in and forgoes the claim. Medical | | | | database of various healthcare practitioners. Medical |
| practitioners lose out on a significant chunk of revenue | | | | billing service providers provide the means to facilitate |
| because of this tactic. | | | | this network. The information of clients is combined into |
| Common tactics used by insurance companies to | | | | an efficient and accountable automated system that |
| delay payments | | | | also offers effective records management and |
| Insurance companies take advantage of the intricacies | | | | efficient processes. Medical providers can leverage |
| of billing procedures. Some of the common strategies | | | | the economies of scale to their advantage, as |
| used by them to delay payments of medical claims | | | | insurance providers have been doing since years. |
| are: | | | | Advantage of medical billing networks |
| Picking out bureaucratic errors to reject claims | | | | Independent medical practices cannot do much on their |
| Most medical practitioners do not have efficient and | | | | own, but collectively they can build an effective |
| reliable billing processes. Insurance companies pick out | | | | system to combat the obstacles in getting payments |
| errors and omissions in the submitted claims to reject | | | | from insurance payers. Billing networks enable medical |
| them. Almost 20% of medical claims go unpaid as a | | | | providers to do business with large-scale insurance |
| result of claim rejections and unaggressive follow-up. | | | | companies on an equal footing. The networks offer |
| This cut in revenue can seriously setback the | | | | the advantages of improved collections, effective |
| operations of a medical practice. | | | | revenue management, lower audit risk and added |
| Low allowable amount | | | | revenue sources. |
| Insurance companies take advantage of their large | | | | All medical practices should use medical billing network |
| size by concurring on low allowable amounts to | | | | services to combat large-scale insurance company |
| medical practitioners. Medical providers are left with | | | | tactics to deny and reject claims. Healthcare providers |
| little choice but to go with the low sums of money as | | | | can use network services to maximize revenue and |
| competing insurance companies also offer the same | | | | streamline revenue management processes. |