Top 5 Challenges Faced by Medical Billing Services and How to Overcome Them

These days, a hospital's financial stability and operations are crucial. The medical billing function takes care of this aspect, which plays a vital role in ensuring accurate and timely reimbursement of the healthcare services provided. Thus, medical billing ensures a smooth revenue cycle and improves cash flow so hospitals can invest more in technology, resources, and patient care.

Medical Billing – A Complicated Function

Medical billing is a highly complicated function that involves navigating complex rules, coding systems, reimbursement rules, and compliance regulations. At the same time, the landscape of healthcare regulations is constantly changing. This further adds to the challenge. If these challenges are not met, they can lead to claim denials, financial losses, and delayed payments.  

In this blog, let us understand some common challenges that medical billing services face and how to overcome them. This will ensure optimized and consistent revenue streams for the healthcare facility or organization.

• Documentation and Coding Errors:

 According to an Equifax audit, it was discovered that hospital bills exceeding $10,000 had an average error of $1,300. So, it can be said that medical documentation and coding are inherently error-prone. This is due to their complexity and scope for human error. Due to incorrect, inaccurate, or incomplete coding, claim denials and payment delays can occur. In case of insufficient or incomplete coding, a physician's note may lack detailed information about a patient's symptoms, examination findings, and treatment plans. This challenge can be overcome by providing appropriate training to the coding and billing staff and the concerned physicians so they can have a strong understanding of accurate documentation and coding practices. Also, an incorrect diagnosis code may be assigned. Alternatively, an erroneous code that does not match the symptoms documented could be keyed in. In this case, every coded bill can be taken through multi-level quality checks before processing the codes.

• Lack Of Knowledge About Guidelines for Updated Coding:

Sometimes, the billing department or the coding staff may not be aware of the latest changes in the International Classification of Diseases (ICD) coding system. As a solution, it is advisable to invest in modern tech solutions such as EHR and coding software. This will help automate processes and stay updated with the latest guidelines to ensure a fitting medical billing service system.

• Insurance Claim Rejections and Denials:

According to Equifax, doctors in the USA believe approximately $125 billion is lost annually. This is due to poor billing practices. So, insurance claims can be rejected or denied due to various factors. At the same time, insurance verification in medical billing can be a difficult task. This could be due to multiple intricate factors, such as complex insurance policies, frequent changes in insurance-related information, and varying coverage plans. For example, the patient data or information could be inaccurate or incomplete. Misspelled names or incorrect insurance policy numbers could result in claims denials. In this case, a possible solution can be to make the front office verification foolproof. This will ensure that accurate and complete patient information is captured right at the initial stage of patient registration. 

• Lack of Preauthorization

 Also, insurance claims are sometimes rejected due to a lack of preauthorization or prior approval. Some ailments, such as occupational, speech, and physical therapy, require prior authorization. In this case, the right solution is to dial the insurer and inquire about the latest guidelines pertaining to the treatment. Even if you know them, it is a good practice to have prior approval.

• Regulatory Compliance

 Healthcare providers must adhere to compliance requirements such as HIPAA to maintain high patient safety standards. Even if a healthcare provider unintentionally overlooks the compliance requirements, they can be put into challenging legal situations. For example, before 2015, all healthcare providers in the USA were using ICD-9 coding systems. However, when the ICD-10 coding system was introduced, there was a substantial increase in the diagnostic codes available. These went from 13000 codes in ICD-9 to 68000 codes in ICD-10. The result was a tremendous change in documentation requirements, coding structure, and specificity. As a solution, providers can stay informed, engage compliance teams, engage with payers, and seek external expertise.

Furthermore, the security of patient data can be undermined. This could be due to unauthorized access to sensitive information through disclosure of patient health information (PHI) in a public medium. The solution to this issue is establishing clear policies and procedures while prioritizing staff training and implementing strict access controls to manage patient data effectively and securely. Healthcare providers often opt for outsourced medical billing services to ensure regulatory compliance.

Conclusion

Thus, it can be seen that medical billing and coding services are essential for healthcare providers. They help in receiving proper reimbursement and maintenance of financial stability. Healthcare providers and clinicians face several challenges while delivering such services. These complexities and challenges can be overcome with the solutions presented here.   Medical billing services often pose challenges for healthcare practices. Nonetheless, with OmniMD's proficient team, you can be confident that your outsourced medical billing system is managed adeptly. We aid in reclaiming lost revenue, reducing claim denials, and accelerating payment processes, allowing you to prioritize delivering exceptional patient care. Reach out to us for further details!