Driving to my night shift at the ER, I notice the flashing fuel gauge on my dashboard.

I take a sharp right turn at the nearest gas station to fill up the tank. Before fueling, I insert my credit card. The fuel does not dispense unless I do. Filling up my tank now and paying later is not an option.

Collecting payment from a customer before filling the gas tank seems completely logical, and is simply the way it is done. Once the customer fuels and drives off to an unknown destination to try to chase down payment would lead to a wild goose chase.

I believe it is this same ‘wild goose chase’ which often plagues practicing physicians. Physicians find themselves under constant pressure to get paid for the work they do.

The creation of the Affordable Care Act in 2010 shifted reimbursement models from the fee-for-service models to a value-based payment modules.

The intention of the government to incentivize efficiency is noble, yet often leads physicians on a wild-goose chase for reimbursement. This trickles to the patients, often sacrificing their healthcare and leaving them confused and frustrated as well.

As a physician, it feels like insurance claim denials are becoming more frequent.

Simply misspelling a patient’s name can cause a discrepancy between a patient’s ID and the insurance record leading to a denied claim. Denials can take many hours to deal with, leading to increased cost, time, and frustration for the physician’s practice and the patient.

Over the years, I have garnered some excellent tips that any physician can include on their checklist to decrease insurance claim denials:

• Check if the patient’s health insurance coverage has lapsed, and obtain proof of new insurance.
• Be sure the claim is not missing a modifier, or that the modifier is invalid.
• Avoid any mismatch between the actual diagnosis and the service performed leading to the appearance of a lack of medical necessity.
• Check to see if the particular service is covered under the patient’s insurance plan benefits.
• Be sure the claim is not missing prior authorization or missing the effective period of time within which pre-approved service must be provided for reimbursement to occur.
• Double check for errors or typos while collecting pertinent information from the patient during data entry process for a claim.

Following these simple steps, and integrating them into your team protocols will reduce the chance of a ‘wild goose chase’ between you and your insurance reimbursements.

Of course, another effective solution for several physicians is to leave insurance behind altogether. Some physicians have opted out of accepting insurance, avoiding the hassles and changes resulting from healthcare reform.

These physicians believe that in order to best help their patients, they need the freedom to spend more time and do the required testing that will help them discover out what’s really wrong with the patient, and not just prescribe a drug to cover up symptoms.
While this fee-for-service model would be wonderful for every doctor to follow, the reality for some is that their entire patient base may not have the means to pay out of pocket.

There is however, a middle ground, that can help physicians move to the fee-for-service option while still having an insurance based practice.

Using Telemedicine technology in the practice, physicians can offer the option to virtually treat patients who are willing to pay out of pocket for convenience. A Telemedicine patient will pay upfront to save time and have the convenience of a virtual visit, avoiding a trip to the doctor’s office. Telemedicine platforms allow us as physicians to keep the entire payment, while treating the patient and offering convenience.

Dr Jay Taylor, president of the American Telemedicine Association, and a long time champion of Telemedicine has a very clear view of the future of medicine: “while a lot of my colleagues look at telemedicine as something very special and new and advanced, I say the medical profession has been decades behind all the other service industries. Think about it. The Healthcare delivery system is the largest service industry. Yet the entertainment industry, the banking industry, even the food industry figured out years ago how to bring their services to the consumer.”

While some physicians opt out of avoiding any form of insurance whatsoever, the telemedicine allows flexibility of setting full or limited availability for virtual access to the physician’s own patients.

At the end of the day, the reimbursement for physicians is the fuel that drives the practice. Even though conventional methods work, the alternatives we now have give us new ways to fill up the tank