Biggest Medical Billing Challenges

Medical billing is one of the most difficult aspects of running a healthcare practice. It has several codes and regulations that you need to keep in mind while doing billing. The worst part is that the smallest mistakes can go a long way and cause future problems. This is why you need to know the following billing challenges and their solutions.

Uneducated Patients

One of the biggest medical billing challenges is to engage your customers in the process. It’s incredibly hard to keep your patients informed and educated when it comes to billing time. This problem is something that most medical billing experts have to face.

You may be surprised to know that a study shows when a patient has an idea about their medical expenses or bills, there are more likely to pay the bills quickly. But for this, they should know the payment options, their balance, and other things related to the payments.

In other words, it’s important to keep your patients aware so that you can get your fees as early as possible. You can do this by using the best systems, management software, and billing software.

If you still struggle to overcome this problem, it’s best to outsource your medical billing task. The best billing providers have a highly experienced team that can deal with any difficult issue.

Different Types of Software

It is important to note that your clients can have a completely different PM or HIS system. This means you have to deal with different processes and logins. On the other hand, your billing experts might also have to work with various data formats.

Unless your team has years of experience or has already worked with different systems, they need to give a lot of effort and time to perform this task. What’s more? Navigating several systems at the same time and long hours at work can lead to fatigue and increase the risk of mistakes.

American Medical Association conducted research that shows that the healthcare system incurs the most expenses on the administrative department. Not to mention, it results in the waste of a total of $266 billion a year.

If you want to save your money and time, you can opt for cloud-based RCM technology. It will allow you to efficiently manage data and streamline the workforce on a single platform.

Insurance Related Problems

Insurance problems are one of the main causes of the claim denials. Generally, it happens when a patient visits your facility routinely, your billing experts may assume that their converge plan and insurance provider may not have changed. This is why, most often, your experts don’t check eligibility, leading to denials and late payments.

As insurance details can change at any time, you need to have a verification step in your medical billing procedure for every patient, no matter if they are regular or one-time patients. It’s better to check all four potential reasons for denial, which are:

Un-authorized services
Terminated coverage
Services not offered by the plan
Already reach maximum benefits

Keep in mind that this problem has nothing to do with the patients and everything to do with the insurance companies. Due to high deductibles, limited coverage plans, and other issues, patients themselves don’t know whether their insurance will cover them.

When you have a procedure in your billing process that can check patients’ insurance provider and plan, it will reduce any risk of insurance-related problems at the time of billing.

Upcoding or Undercoding Issues

Undercoding and upcoding can happen both deliberately and unconsciously. And these issues will cause problems for patients. To make it clear, upcoding occurs when you enter codes into a patient’s bills for services that you have not given them.

As a result, you will be able to raise the final bill for the treatment. On the other hand, undercoding is when you don’t use the right codes to charge an individual for all the expenditures. Typically, professionals do this to avoid audits.

Well, keep in mind that both practices are illegal, and depending on your mistake, it can also lead to considerable charges or criminal prosecution. But both of these problems can also happen accidentally. Generally, inexperienced individuals can make these mistakes.

Moreover, when your staff has a lot of work and doesn’t have time to cross-check the codes, these mistakes become common. The best way is to hire enough team members that can perform the job without stressing out.

Lack of Resources

It is important to have enough resources to create a well-structured and ideal billing department. From patient education to customer support and quality software and modern tools to a number of team members, everything is important if you want excellent results.

Not only will these resources save you from managing medical billing through traditional ways, but they will also reduce the risk of problems in the future.

Medical billing resources are also important to maximize your revenue and maintain a high number of clean claims. If you accurately record your billing information and perform the procedure with modern tools, you will also prevent the risk of possible penalties and charges you may have to face. Having the right resources will also help your staff perform the procedure easily and with few steps.

Amendments in Coding Laws and Regulations

Medical billing professionals need to educate themselves with the changing coding laws and regulations. You need to understand that the government makes amendments in coding laws and introduces new medical coding laws to make the process easy.

However, when you don’t know the codes or laws, you will not be able to perform the task accurately, leading to problems in the future.

The best solution to these problems is to train and educate your in–house medical billing team. This way, they will understand the laws and can practice them regularly. Just keep in mind that the slightest mistakes in the billing procedure can cause a great problem for you and your patients.

Bottom Line

Medical billing is a complex and challenging procedure. To perform this procedure, you need the right qualification, training, experiences, and tools. Most importantly, you need to keep yourself aware of any new laws and regulations as well as new codes. You also require specific software so that you don’t have to record data manually.

Keeping all these things in mind might be challenging for you, as it can prevent you from giving your time and effort to your medical facility.

This is why it’s best to outsource your medical billing procedure to a fully equipped and highly experienced service provider like Lokesh James. They have qualified professionals and different software and tools to limit the risk of problems. Additionally, by having an excellent medical billing mechanism, you can also satisfy your customers.