If someone ever wants to start a small consulting firm, I feel like this is a brain trust and is realistic but not sure how to make it profitable.

Keep offices and clinics up to date with current insurance requirements and guidelines.

Every year, we see a flood of new insurance onto the market and they seem to keep coming from every angle. Whether it is a new plan on the marketplace, a new Medicaid company or the ever expanding model of Medicare Advantage plans. Each and every one of these plans has their own caveats and intricacies.

My solution, just tell providers what they need to do. Don’t send me to a site with a library of videos that I have to sift through in order to get the information I need. Third parties are largely unhelpful and everyone needs to come into the equation understanding that insurance companies are for profit entities and if they pay money out, it is less to their bottom line.

Big to small, the last thing small clinics need is for one more thing to do but if a person was in the background that kept track of all of the updates and what needs to be placed with claims, offices, patients and insurance companies would all be happier.

We are currently experiencing a new preauthorization requirement for certain plans and another plan requires certain modifiers that others don’t require. The frustration with this is that, we don’t find out until after the fact. Rejection letters come in and the recourse is very limited because if you are in-network with the plan, they expect you to know the rules.

A 1-2 page document to show EXACTLY what needs to be done, the issue on the business side is that the document would take a few hours to put together and would be relevant for about 2 months until everyone figures out the rules. But the first quarter of every year would be the exact same because everyone is in the same boat and doesn’t know until they don’t

I know this is more of a rant but as a small office, you can start to see the direction that healthcare is going.  More and more offices are going to be offering cash discounts or just not take insurance in general because it becomes very burdensome and time consuming to not get paid (essentially not even be able to bill the patient because the claim gets denied and once a claim is denied, the patient is not responsible in many cases).

At the end of the day, accepting insurance is for the most part a game but you have to know the rules before the game starts. It’s very frustrating and confusing; honestly it can be very costly because you end up having to eat a lot of the charges. So when we ask for insurance cards at the first of the year, we are not doing it to entertain ourselves, we are trying to save everyone a little bit of headache but unless we know the rules, you can spend a lot of your day beating your head against a wall.

So in ending, a message to patients: having the correct information is key and messages to insurance companies- just tell us what we need to know. It will make everyone happier.