Is Your Practice Ready to Deal with the Challenges of Medical Billing?

Running a successful practice is dependent mostly on the reimbursements and profits that your practice makes. Regardless of what is said or assumed, without enough cash flow, you cannot even provide proper healthcare to your patients. If the reimbursements are not being made within a set time frame, at a standard rate, then your practice is not being paid enough to stay afloat. Moreover, your staff is more than likely stressed and overwhelmed with following up with insurance providers and patients for these payments. The whole medical billing process can just be a very challenging, time-consuming, and tedious task.

What is the medical billing process?

There are quite a few misunderstandings regarding the medical billing process, and what it entails. The medical billing process is often mistaken with medical coding, with many thinking of them to be the same. While both are interrelated and crucial for the successful management of the revenue cycle, they are not the same.

Medical coding refers to assigning medical codes to the diagnosis and treatment rendered to patients based on well documented clinical notes, comprising of ICD-10-CM, CPT, and HCPCS Level II classification systems. It is just one of the important steps that need to be performed, rather accurately, during the medical billing process.

The medical billing process is a list of tasks that need to be performed for a healthcare provider to be paid for the services rendered. A mistake made during any of these tasks would negatively impact the medical billing process and create a challenge for your practice. The tasks involved in a medical billing process are:

Patient Registration

Albeit the first, this step is quite crucial and determines how many issues will arise going forward. During this period, it is important to check patients’ insurance eligibility and verify that they are covered for all services that might be provided during the visit. Moreover, it is important to get the patient’s billing information during this step to collect co-payments and full payments in case of insurance ineligibility. If insurance verification isn’t performed, there will be claim denials and rejections later on.

Diagnostic and Procedural Coding

This step includes the conversion of medical data from clinical charts and notes to medical codes based on ICD-10-CM, CPT and HCPCS classification systems. Accuracy of coding when it comes to diagnosis and procedures performed is crucial for claims submission and reimbursements. Inaccurate coding is one of the most common reasons why claims get denied.

Filing and submission of claims

After you have coded the patient records and checked that it meets all compliance guidelines with payer requirements and HIPAA laws, you can submit this claim to the payer electronically. Reimbursements will be done when the claim has been accepted by the payer and adjudicated.

Patient payment collections

Patients who aren’t covered by any insurance provider need to pay for their visit on their own. It is the job of your staff to create an invoice for them, and follow up to ensure timely payment. It is one of the tasks involved in the medical billing process.

Challenges of medical billing

Medical billing process is a long and complex one with more than enough opportunities for failure. If done incorrectly, the challenges of medical billing create a stressful environment at your practice which is why it is recommended to outsource the entire process to professional vendors. However, your practice needs to be aware of them to have a better understanding of what the vendors are doing for you. Some of the most common challenges of medical billing include, but are not limited to:

Denials and Rejections

Claim denials and rejections are the biggest issues that can seriously hurt the cash flow at your practice. Denials of a claim themselves cost your practice up to $40 each time and create a backlog of cases that your staff will need to either appeal or rectify and reapply. All of this needs to be done while working on multiple new claims as well. If your practice cannot keep up with multiple claims submissions at the same time, then there are going to be quite a few issues with timely submission of claims which in itself are enough for a denial.

Lack of Patient Eligibility Verification

Your staff is responsible for checking patient insurance eligibility at the time of appointment scheduling. The purpose of this is to ensure that the patient is insured and covered for the services that have been requested. If the patient is not covered, it gives the patient ample time to be prepared to pay for the services out of pocket instead. Not checking eligibility results in denials, which as mentioned above, hurts the cash flow and reimbursements significantly.

Incomplete and/or Inaccurate Patient Information

Another challenge of medical billing is mistakes made while collecting patient information ranging from mistakes made in patient name and age to billing information errors. Sometimes, the information is inaccurate as much as it is incomplete because your staff probably was backlogged and tried to hurry through the task, leaving behind a few unanswered questions.

Lack of Automation and Technology

Lack of automation of the medical billing process means that a lot of work needs to be performed manually by the medical biller in your staff. This may not seem that big of a deal except for the fact that multiple claims are being submitted on a daily basis as you are seeing more than one patient a day.

All the tasks involved in medical billing such as collection of patient data, insurance verification, medical coding, and claim submission need to be done in a timely manner. However, as no technological help is made available to your staff, they won’t be able to do it manually and even if they do, there are going to be quite a few errors. All of this will result in claim denial. This is one of the biggest challenges with medical billing, although it can be easily solved by partnering with Practolytics, a medical billing expert with over 20 years of industry presence.

ALSO READ – Pros and Cons of Outsourcing Medical Billing at Your Practice