A Look At The Dwindling Revenues Within The Medical Field

A Look At The Dwindling Revenues Within The Medical Field

As has been feared by physicians around the country, mandated healthcare has caused a drastic fall in the amount of profit many private and group practices are seeing. Most of these plans are some form of managed care program that standardizes payments with a ceiling for each type of service being performed.

Unfortunately, this is forcing doctors to work longer hours and even harder than they had in the past in order to turn a profit and this is neither good for them nor for the patients they see. A tired physician is not at his best, so it is incumbent upon him or her to find ways to counteract dwindling revenues without working absurdly long hours to the detriment of patients being cared for.


Standardized Payments A Cause For Concern

It may seem like a logical step to standardize payments for services by lumping them into hierarchical categories. For example, an insurance company may have a ceiling on the amount of money they are willing to pay for an appendectomy, but what if there is a complication during that surgery? Does the surgeon get more money for an operation that turns into a 3 hour event as opposed to a procedure that typically is completed within 1 to 2 hours at most? Usually this is not the case. Doctors are disenchanted with the payment system of most managed healthcare programs and when it comes to government sponsored Medicare and Medicaid, those ceilings are quite low indeed.

Getting Paid Is A Huge Part Of The Problem

Then there is the problem that many of these procedures and diagnostic visits are just not being paid for by CMS (Centers for Medicare and Medicaid Services). This usually results from improper coding when billing the Medicare provider or from a procedure that is not deemed to be medically necessary or pre-approved. If a doctor has any hope of staying in business and operating at a profit, it is important to find ways to recover payments from insurers, especially Medicare and Medicaid.

Getting paid is a huge part of the problem and there are some statistics that show doctors have trouble collecting as much as 50% (or more) of what is due to them. The best suggestion here would be to hire the services of a medical claims recovery team who are expert in analyzing why payments have not been made and then going about recovering the money due to the physician.

On one hand it seems as though hospitals and some doctors should be collecting less money for their services and this has been a bone of contention for many years: the high cost of medicine. However, when consumers take time to stop and think about the fact that doctors are often the fine line between life and death, it makes sense that they should be justly compensated. More and more doctors are being literally forced out of business due to dwindling resources. Little can be done about the ceilings insurance companies impose, but much can be done to recover payments due to them.

If you are a doctor, clinician, hospital director or medical professional of any type seeking to turn a profit however small, your best course of action would be to hire a professional recovery team so that you have a constant flow of revenue. It is no longer just private patients who aren’t paying their bills, but now insurance companies are added to the mix. Want to stay in business? Let the professionals get your payments for you. That may be your only option.