The US fertility market is expected to grow at a CAGR of 4.78% till 2033. As studies say, the U.S. fertility market is mainly influenced by the enhanced developments in technologies in health, as well as improved efficiency in in/vitro fertilization.
Considering these factors, providers across the country must enjoy ample amount of revenue for their rendered services.
But the dark side of the moon shows, they are not obtaining accurate and timely reimbursements thus falling behind the revenue growth curve.
What makes fertility billing difficult compared to other medical billing services?
Let’s dive deep to understand the critical nuances of fertility billing services before we jump into the solution to revive revenue.
Unique Challenges of Fertility Billing
One of the major challenges in fertility billing is the ambiguity surrounding insurance coverage. Unlike other medical services, insurance coverage and benefits for fertility procedures are highly variable making it difficult for the providers to maintain a streamlined process.
- State-Mandated Coverage: Provision of fertility treatments ranges from state to state; some states cover only diagnostic tests while others do not cover IVF, which bemuses patients and providers.
- Employer Plans: Fertility treatments for employer-sponsored plans are allowed, however, there is usually a limitation such as the lifetime dollar limit or the terms of eligibility.
- In/Out-of-Network Providers: When in search of a fertility center, even if insurance may seem to cover the expenses, patients may end up paying more if the center is out of network.
- Treatment Exclusions: Some policies leave certain procedures out such as egg freezing or genetic tests, which explain why effective billing communication is important.
Infertility therapies tend to occur in stages that may take weeks to months, from the preliminary examinations and tests to hormonal treatments, and procedures such as IVF. Charging for every step requires some strict documentation and perfect coding to avoid any slowness or rejection by insurance.
Access to insurance to fertility billing services remains a big controversy among insurance providers. Every patient has specific needs for policies, which need thorough analysis to understand what is paid, frequently making some interventions pre-authorization, long calls to insurance companies, and a clear understanding of what the term “medically necessary” means. Although this process is tedious and may at times be most annoying, it is important for that patient to get the benefits she or he is entitled to get.
Denials are one of the most frequent obstacles seen in fertility billing. The aspects of coverage present many challenges for billing teams who are often faced with denied claims. It should however be noted that being an advocate for patients and taking on some of the above challenges proactively will ensure patients access the coverage they require.
Fertility treatments even with insurance mostly require a lot of money full amount, sometimes little is covered. Communication regarding financials counterparts is effective to know what one should expect from others. Most centers provide financial advice, and instalment plans for the billing charges, but it may involve technicalities as complex as the procedures involved. Trust and transparency with patients will go a long way in ensuring that this financial burden is eased.
To overcome these obstacles, you can implement the following strategies like-
- Improve patient data collection and transition
- Maintain accuracy in coding and documentation to increase first-pass claims rate
- Establish a well-defined denial management process
- Implement automation in billing and claim submission process
- Train and educate staff regularly
OR A Specialized Billing Partner: The Easy Way!
Contracting out the services of fertility billing to a medical billing company has its own benefits.
They provide specialized knowledge in fertility billing, insurance policies as well as the typical limitations and exclusions in cover, and caps. They are very effective in managing pre-authorization and claims to reduce the number of denials and increase the reimbursements.
These professionals can reclaim reimbursement by implementing their extensive knowledge and expertise. Also, it increases patient satisfaction as they give clear financial advising about a patient’s coverage and payment, the explanation of which could be unclear sometimes.
This way, fertility centers may minimize points of view related to administrative burden and augment the quality of care they provide by bringing payments issues to experienced professionals.
