Until recent years, it wasn't uncommon for hospitals to use their medical billing to cross subsidize lesser expensive services with more profitable services, now with the revamping of several codings and programs, this can lead to outright denials of medical billing claims.

The Centers for Medicare and Medicaid Services has been giving these types of claims a much more detailed look. Billings that show to be using cross subsidizing to allow for reimbursement based on submitting a claim for both a more profitable service as well as lesser profitable services may lead to denial of the medical billing claim.

The downside to this measure is that if certain unprofitable services aren't reimbursed, many physicians will simply stop offering them to their patients. Currently, the medical billing reimbursement ratio of insurer payments to hospital charges was once 1:1 but is now 2:6. In order to be profitable and stay in business, these hospitals must do something to improve their medical billing reimbursements. Careful monitoring of your medical billing for maximum reimbursements is one way.

If you're not sure that you're getting maximum reimbursements, have your billing practices audited by an independent party, the results may surprise you. If you do bundle your medical billing, check and double check to make sure you have proper coding and documentation to back up your medical billing claim for full reimbursement. Another way to ensure you get the maximum returns for your services rendered, is to outsource your medical billing to a third party partner.

If you're ready let someone else keep up with the paper chase and documentation nightmare that medical billing can sometimes be, outsource your headaches to the pros and watch your reimbursements grow and know that proper reimbursement techniques are being used.

Labels: claims, denials, medical-billing