Ever wondered why healthcare expenses continue to climb despite efforts to limit them? Have you ever considered the complexities of the healthcare billing process and how they affect patients and physicians? Physicians encounter many problems in getting paid for their rendered care services.
This guide delves into the most common medical billing and coding challenges hindering the progress of healthcare facilities and offers tips to overcome them. So, if you are done staying awake at night, thinking about the complexities of medical billing, this guide is for YOU! Let’s get right into the business without stalling.
- Challenge # 1 – Ever-evolving Regulatory Requirements
- Challenge # 2 – Different Requirements for Different Payers
- Challenge # 3 – Keep Patient Information Up-to-Date
- Challenge # 4 – Missing or Incorrect Coding and Documentation
- Challenge # 5 – Insurance Claim Denials and Rejections
- Challenge # 6 – Account Receivable Management
- Challenge # 7 – Administrative Burden & Physician Burnout
- Conquer Billing Challenges and Focus on Patient Care: How MediBill MD Empowers Physicians
- Bottom Line
Challenge # 1 – Ever-evolving Regulatory Requirements
One of the most difficult issues in medical billing is keeping up with the ever-changing healthcare rules. Physicians must stay current on local, state, and federal laws such as the Medicare Access and CHIP Reauthorization Act (MACRA), the Affordable Care Act (ACA), and the Health Insurance Portability and Accountability Act (HIPAA). Noncompliance with these requirements can result in significant penalties, and compromise the practice’s reputation.
Providers spend over $38 billion annually on regulatory compliance issues. For some hospitals, the regulatory burden rises to a staggering $1,200 each time they admit a new patient.
American Hospital Association (AHA)
How to Overcome This Challenge?
Tip # 1 – When you have compliance questions, it is beneficial to have the assistance of a professional association. Professional groups notify their members about critical regulatory changes, giving them time to prepare.
Tip # 2 – Sign up for newsletters. Regulatory bodies, lawmakers, and legal firms send out informative newsletters via email to their subscribers.
Tip # 3 – Check official websites, like the Office of Inspector General (OIG), to stay up-to-date on regulatory changes.
Tip # 4 – Hire a compliance officer or outsource your operations to a professional medical billing company.
Between now and 2026, the demand for healthcare compliance officers will increase by roughly 8%.
US Bureau of Labor Statistics
Challenge # 2 – Different Requirements for Different Payers
All commercial payers, Medicare, and Medicaid have unique billing criteria. Medical billing personnel might spend a significant amount of time cleaning claims to ensure they meet the requirements of different payers.
- Medicare – Charges from Medicare participants aged 65 and older.
- Medicaid – Costs imposed on beneficiaries enrolled in state Medicaid programs.
- Private/self-pay/other – Charges imposed on patients who have private health insurance through their employers, those who do not have insurance or prefer to self-pay, Medicare Advantage patients, and all other patients.
How to Overcome This Challenge?
Tip # 1 – You can solve this problem by automating as much of your billing process as feasible. For example, many electronic health records (EHR) systems allow providers to customize templates for typical payer rules to assist you in gathering the necessary information during office visits.
This eliminates time-consuming data entries. Besides, EHR software helps you create a robust claim edit library to clean up claims before submitting them to your clearinghouse.
You can also automate claim submission. Scheduled batch submissions allow you to reduce the processing strain on your system by submitting all claims outside of typical business hours.
Tip # 2 – Hire a professional medical billing company like MediBill MD that houses certified coders and billing specialists with rigorous training on how to comply with the varying requirements of different payers.
Challenge # 3 – Keep Patient Information Up-to-Date
Clean claims begin with correct patient information. It requires you to verify patients’ insurance information regularly. Failure to do so can risk increasing your days in A/R due to eligibility denials.
Your clinic should have procedures to verify insurance coverage, eligibility, and necessary authorizations before check-ins. Payers might sometimes deny claims for minor inaccuracies in patient information, so patients should double-check their demographic information.
How to Overcome This Challenge?
Tip # 1 – Your practice can use solutions such as Patient Portal to update patient information. It enables patients to check or amend their information directly in your system. This eliminates data transfer errors from paper forms and saves your front-desk workers’ time.
Challenge # 4 – Missing or Incorrect Coding and Documentation
Correct coding and documentation are optimal for generating clean claims. However, providers have limited time during office visits, and EHR issues cause physician burnout. Overwhelmed providers may overlook important codes or supporting paperwork.
Hospital coding errors account for 63% of medical billing problems. Besides, the quality and accuracy of clinical documentation account for 44% of all medical billing errors.
Gitnux
How to Overcome This Challenge?
Tip # 1 – Workflow redesign and training can help you solve recurring code and documentation issues. During a workflow redesign, you evaluate and adapt your coding and documentation processes to ensure they fit into your providers’ daily work.
For example, an efficient office-visit workflow involves patient documentation and coding. You can also enable EHR features that notify healthcare practitioners about missing codes and documentation in real time.
Tip # 2 – After you’ve created your new workflows, training can help you get all providers up to speed. EHR training improves system satisfaction while lowering the risk of burnout.
Challenge # 5 – Insurance Claim Denials and Rejections
Insurance verification in medical billing can be challenging due to complex insurance policies, varying coverage plans, frequent changes in insurance information, and the requirement to collect correct and up-to-date patient data.
Some common issues that hospitals encounter and may lead to claim denials or rejections are:
- Inaccurate patient demographics, like misspelled names or wrong insurance policy numbers, can lead to claim denials.
- Failure to get prior authorization for therapies, such as occupational, speech, and physical. Besides, some operations like penile prosthesis surgery require prior authorization.
- The administrative personnel may ignore insurance policy subtleties, including exclusions for specific services or treatments. The insurance companies refer to it as a non-covered or experimental treatment.
- Common coding errors, including upcoding, undercoding, missing modifiers, etc.
Billing errors cost physicians in the US an estimated $125 billion in revenue.
Pennsylvania Office of Rural Health
How to Overcome This Challenge?
Tip # 1 – Make your front office verification foolproof to obtain accurate and complete patient information from the start of patient registration.
Tip # 2 – Call your insurer for the most recent treatment guidelines, even if you already know them. Make it a point to have prior approval documented.
Tip # 3 – Implement effective claim review and auditing systems to identify and resolve issues before submitting claims.
Tip # 4 – Train your medical billing and coding staff on billing requirements to avoid possible denials and rejections.
Challenge # 6 – Account Receivable Management
Nothing has more of an impact on healthcare operations than delayed payments. It can negatively impact healthcare companies’ financial performance. Healthcare practitioners frequently interact with many insurance payers, each with its own regulations, policies, and reimbursement procedures. The entire procedure increases the strain on patient care quality.
After submitting claims, a clinic may have to wait an extended time before getting paid. There could be various reasons for this, including long processing times, a large number of claims submitted at the same time, administrative inefficiencies in their reimbursement process, and so on. All of this affects the clinic’s financial flow.
77% of healthcare providers report that collecting payment takes more than 30 days. Besides, the same survey shows that 56% of patients fail to pay a health-care cost exceeding $1,000.
Health Leaders Media
How to Overcome This Challenge?
Tip # 1 – Implement EHR systems and other RCM tools to improve billing efficiency. Reducing coding errors and enhancing documentation helps to minimize A/R days. Follow up on unpaid claims and denials regularly and resolve disagreements with insurance companies to speed up the process.
Challenge # 7 – Administrative Burden & Physician Burnout
Billing and administrative procedures can be time-consuming and distract one from patient care. Physicians may need to engage more staff to manage billing tasks, which can be costly for small practices. As a result, many healthcare providers running individual practices handle this themselves, leading to burnout.
Physicians dedicate an average of 15.5 hours per week to paperwork and administration.
Medscape Physician Compensation Report
| Specialty | Hours Spent on Administrative Duties |
|---|---|
| Physical medicine and rehabilitation physicians | 19 hours/week on average |
| Critical care, internal medicine, nephrology, neurology, and oncology specialists | 18 hours/week on average |
| Family medicine physicians | 17 hours/week on average |
| Cardiologists, psychiatrists, and diabetes and endocrinology specialists | 16 hours/week on average |
| OB-GYNs, pediatricians, and general surgeons | 15 hours/week on average |
| Orthopedic surgeons, urologists, and otolaryngologists | 14 hours/week on average |
| Emergency medicine physicians and gastroenterologists | 13 hours/week on average |
| Dermatologists, plastic surgeons, and radiologists | 11 hours/week on average |
| Ophthalmologists | 10 hours/week on average |
| Anesthesiologists | 9 hours/week on average |
Physician burnout is a state of emotional, bodily, and mental weariness produced by extended stress in the profession. Burnout has multiple causes, including a lack of autonomy, a heavy workload, and a poor work-life balance.
Burnout in physicians increases the likelihood of medical errors, worsening patient satisfaction scores, and high absenteeism rates. It exacerbates physician scarcity in specific locations and specialties, increasing wait times and reducing access to patient care. Furthermore, burnout has been linked to a deterioration in overall care quality.
In 2023, half of all practicing physicians reported burnout. Burnout has decreased from its all-time peak in 2021, yet it is a persistent issue. Emergency medicine, hospital medicine, family medicine, pediatrics, OB-GYN, and internal medicine are at high risk for burnout due to extreme stress, long hours, and emotional depletion.
Becker’s ASC Review
How to Overcome This Challenge?
Tip # 1 – Smart EHR systems combined with artificial intelligence (AI) algorithms can automatically recommend pertinent diagnoses, treatment plans, and order sets based on patient data, cutting clinicians’ search time for relevant information.
Tip # 2 – Automating routine administrative procedures helps streamline administrative workflows. Appointment scheduling systems can intelligently match patient availability to physician calendars, reducing scheduling conflicts and manual work.
Tip # 3 – Automated billing and coding systems can reliably assign codes, speed up the billing process, and reduce errors.
Tip # 4 – By outsourcing the intricate medical billing process, healthcare firms can increase efficiency, save administrative costs, and improve the overall patient experience.
Conquer Billing Challenges and Focus on Patient Care: How MediBill MD Empowers Physicians
The intricacies of medical billing can take up valuable time and resources from physicians, limiting their capacity to provide optimal patient care. Here’s how MediBill MD, your trusted medical billing and RCM partner, can help you solve these frequent challenges:
Regulatory Maze Masters
Maintain compliance with ever-changing regulations. Our team stays updated on challenge #1: evolving regulatory requirements, ensuring all claims follow the most recent guidelines.
Payer Proficiency Monitors
Rules vary depending on the payer. We handle the difficulties of challenge #2: varying requirements for different payers, ensuring that each claim is submitted using the appropriate format and evidence for the insurance.
Patient Data Protectors
We prioritize accurate and current patient information, reducing the problems associated with challenge #3: keeping patient information up to date. Our secure platforms ensure more efficient patient data management.
Coding & Documentation Champions
Our professional coders thoroughly analyze documents to reduce challenge #4, missing or incorrect coding and documents. This assures correct claim filings and lowers the likelihood of denials.
Denial Defense Team
We fight for your proper reimbursement. Our professionals work hard to tackle challenge #5, insurance claims denials and rejections, optimizing revenue recovery.
A/R Managers
Manage your receivables efficiently. We tackle challenge #6, account receivable management by proactively following up on outstanding claims, minimizing delays, and maximizing cash flow.
Burnout Navigators
Free yourself from administrative burdens. We address challenge #7, administrative burden and physician burnout by handling the complexities of medical billing. This allows you to focus on what matters most – providing quality patient care.
By partnering with MediBill MD you can regain critical time and resources. We become an extension of your practice, allowing you to overcome billing difficulties while providing excellent patient care with renewed focus and energy.
Bottom Line
Medical billing is critical to the financial stability and profitability of healthcare organizations. However, it is important to realize that the medical billing landscape is evolving continuously.
Therefore, healthcare practices must stay current on market developments, legislative changes, and technological advancements to conquer these growing medical billing and coding challenges. Besides, if you want to optimize your revenue cycle management process, MediBill MD is always here to help!
