Challenges Associated with Medical Billing   

Healthcare revenue cycle management relies on accurate and efficient billing of patients. Many providers are experiencing challenges in rendering accurate and timely payment for the services provided.    

Billing is one of the most challenging aspects of the healthcare system. Insurers, bill payers, and insurance are causing problems for half of health care providers. Many roadblocks add to the complexity of medical billing. According to recent statistics, healthcare providers are overwhelmed with the changes occurring in medical billing procedures and making changes to meet the needs of new patients.   

The following are some common medical billing issues that can negatively affect revenue and patient satisfaction, whether it is a billing issue at a medical office, surgery center, or acute care hospital.    

Patient Education

Most of the patients are not aware of their medical bills. As healthcare pricing is not transparent, patients assume that having healthcare insurance will cover all their costs. There is a lack of awareness among the people about the insurance coverage and high-deductible plans on a rollercoaster when the medical bills are delivered after their treatment.

Billing Errors

Billing errors lead to an annual loss of $490 billion, and WHO has stated this as “The last unreduced healthcare cost”.    

Despite hospitals’ increased experience with ICD-10, coding issues and errors continue to plague them. An incorrectly coded medical service generally results in the denial of a claim. The elimination of these errors requires constant communication between clinicians and billing staff and regular medical billing training and education. Reducing billing errors is possible by educating the people regarding medical billing and policies and developing innovative solutions.   

Innovative billing solutions can actively eliminate errors within the billing system. Moreover, if an error occurs, accurate and detailed information must be retained within a patient information log. It includes name, account number, cash reimbursement amount, etc.   

A healthcare provider can keep track of all revenue payments and cash flow by reviewing these logs. A medical bill audit is crucial in combating medical bill waste that already costs billions of dollars.   

Late payments

Payment delays seem inevitable when systems rely on patients to pay or insurance companies to come forward and pay for services. The availability of online payment services and credit card payments can make payments more accessible, but implementing these solutions proves challenging for some.

Addressing Different Needs

As different medical payers have different requirements, medical billing staff spends significant time cleaning claims to align with the requirements. The only solution for this time-consuming claim cleaning process is switching to Automation. Using a standard template for collecting information is yet another simple solution for the problem as it reduces the claim denial time and speeds up the payment process.

Incorrect patient information

Reimbursement delays are still primarily due to failure to capture relevant patient information. Registration and scheduling staff play a significant role in this process. The training and education of medical billing staff are necessary to help them understand the information they need to collect and the importance of this data.  

About 8% of medical claims are rejected because of eligibility problems. Billing involves verifying people’s personal and insurance information. When the software solutions are inadequate, the information is outdated. Additional steps are needed to get the correct information and then confirm it before the insurance can fulfil the original goal of getting paid.  

Claim tracking and resubmission

A recent statistic indicates that around 5% of claims are denied each month, and most of these claims are never submitted again. Tracking denials and resubmitting clean claims is a complex and time-consuming process. Having a high denial rate in your practice can result in significant revenue losses. 

Identifying the common reasons for denial is imperative. Several reasons account for the denial, including inaccurate patient information and a lack of documentation. Insurance providers can provide training and support to overcome these obstacles.  

Accounts receivable management

Medical billing errors may be a result of overworked billing staff. Revenue cycle and accounting suffering will be reduced if receivables are kept to 50 days (about 1 and a half months) or less. Automated accounts receivable management is the simple solution to this issue.   

Collecting patient balances

Patient balances are often collected through direct communication. Your medical billing staff will be hard-pressed to keep up with their workload if they are busy with lengthy phone calls. Offer patients multiple ways to pay. Taking advanced payments or accepting payments online will make payments easier for the payers.  

Manual Claim process

Many claims’ processes are automated, but there are still practices that suffer reimbursement penalties due to cumbersome and error-prone manual processes.   

Claim submission by the healthcare provider is not just a push of a button. Providers must utilize robust data collection tools, establish effective communication channels between front-end and clinical staff, and streamline their denials management procedures when submitting claims. Medical coding challenges in manual entry are high, and Automation is the only solution to minimize errors.   

Using MHRCM to handle medical billing challenges

MHRCM can improve your practice’s cash flow. With Staff Augmentation and outsourcing services, you get the medical billing staff you need. Any healthcare provider can accelerate their billing and management process with the help of mhrcm’s revenue cycle consultants, project managers, and trainers. MHRCM takes care of all your medical billing issues.  

Leave a comment

Your email address will not be published.