Shocking Medical Billing Survey

An online survey completed this year by Medical Association of Billers showed some interesting stats from the world of medical billing.

Responding to the survey were professionals from billing companies, single provider practices, group practices, hospital medical records, hospital outpatient, ambulatory surgery and insurance carrier.

The survey results were divided into 6 categories, each representing a geographical region of the nation. For my analysis of the results I have combined each of the stats and divided to come to a national average based upon the results, and a few of those numbers are discussed here.

First let me say that Outsource Management Group, LLC. has no interest in the results nor did we participate in anyway with the results, but I did feel that it at least deserved a mention.

The first and one of the most disturbing stats to me as a professional is that more than half (59%) of all respondents DO NOT review or verify every EOB. So what happens when their claims are denied for what ever reason? And we all know that insurance will deny any claim that they can. Denied claims equal a loss of revenue. So what this survey says is that 59% of all respondents have claims that may have or more likely have been denied and they don’t know it. Would the provider be satisfied knowing this?

Even if they knew that the claim had been denied, did they appeal it? Well there is less than a 50% percent chance of an appeal, this is the other stat that I found disturbing, more than half (55%) of all respondents have NEVER appealed a denied claim! How can that be? This is amazing, do we as billing professionals just take the denial and write it off? I don’t think so and I am amazed that over half of all respondents to the survey apparently do just that! Furthermore, a number of the denials go completely unknown due to the lack of EOB review, so I guess if it not reviewed there is no known denial to appeal!

As I stated earlier we had no part in the survey itself, but I am proud to say that Outsource Management Group, LLC does review and verify every single EOB for accuracy, as well as appeal every single denied claim with all carriers.

Now that I got that all out of my system lets talk about some of the other stats in the survey.

Lets talk about the respondents who have or don’t have compliance plans in place. The national average of providers with a compliance plan in place was just under 50%, with the north west and north central regions having 100%.

The national average of billing companies that have a compliance plan in place was just over 10%. Does this mean that 90% of all of the billing companies who responded do not have a compliance plan? Apparently so, and this is some what disturbing as well. A compliance plan has become a fundamental component of the billing industry.

72% of all responding providers are using a billing service and with all of the above said, I don’t know how a provider decides on a billing service, it has to be a tough decision to allow someone to essentially take care of all of your insurance reimbursement and be able to trust that the billing company is going to get you the maximum reimbursement that is due.

The average charge was just over 8% for the four regions who reported fees. This is acceptable to most providers. The actual fees submitted to the survey varied from 5% – 13% with 13% being higher than most.

The survey contained a few other stats that were not nearly as noteworthy as the ones I have discussed here, but you can see the whole survey here.

This article is not intended to discredit any of our billing colleagues, insurance carriers, providers or otherwise, as the names and exact locations of the respondents were never disclosed. However it does appear that the resources and strategies available to billers are not being utilized to their fullest.

We at Outsource Management Group, LLC do however manage providers at a much higher level than what was given in the survey as discussed, our strategy has always been to get the provider maximum reimbursement through claim audits and follow-up. In doing so we have built lasting and trusting relationships with provider and group clients nationwide. That is something that we are proud of!

View all Articles by: Melissa Clark, CCS-P